LASIK Surgery and Dry Eyes: Understanding Risks and Prevention Strategies

One of the most common concerns patients have before undergoing LASIK (Laser-Assisted In Situ Keratomileusis) surgery is the potential impact on their eye health. Specifically, many patients inquire about the risks of developing dry eyes following LASIK and whether these risks can be minimized. In this article, we will explore the potential risks associated with dry eyes after LASIK surgery and discuss steps that can be taken to reduce these risks.

Understanding the Risks of Dry Eyes Post-LASIK

Proper pre-operative evaluations are essential to determine if a patient is an ideal candidate for LASIK surgery. During these evaluations, it is important to check for any underlying conditions, including dry eyes. The process of cutting through the cornea during LASIK can make it more difficult for the tear film to be maintained, leading to a sensation of dryness. If the cornea is cut, the patient may not always feel dryness, but their vision can become blurred. This is because the cut cornea does not always allow the tear film to be as smooth as it should be.

Preventative Measures Before LASIK

For patients who already have dry eyes or who are at high risk for developing them, several preventative measures can be taken during the pre-operative phase. One such measure is the use of punctal plugs. Punctal plugs are small devices that are inserted into the tear ducts to prevent tear drainage, helping to keep the eyes more moist. Additionally, preservative-free artificial tears and more viscous tear gels are often recommended before bedtime to help maintain the tear film and provide relief from dryness.

The Causes of ‘Dry Eyes’

Understanding the different causes of dryness is crucial for managing this condition effectively. Ben Wilkinson, FRCS, breaks down dryness symptoms into two major categories: 'true dry eye' and 'irritant conjunctivitis', and a new condition called 'dry eye syndrome'. These conditions can have overlapping symptoms, leading to confusion about their causes and treatments.

True Dry Eyes

True dry eye is primarily a condition where the lacrimal glands do not produce sufficient watery tears. It is often associated with dryness in other mucous membranes such as the nose, throat, and vagina. This condition can commonly be linked to an underlying autoimmune condition known as Sjogren's syndrome. Symptoms include a sensation of dryness, grittiness, and soreness.

Irritant Conjunctivitis

Irritant conjunctivitis refers to a condition where the eyes are exposed to more irritants than they can handle. These irritants can range from environmental factors like air pollution, to self-inflicted irritants such as splashes during activities like showering or washing dishes, and even to occupational airborne irritants like solvents or dust. Symptoms include a sense of dryness, grittiness, and soreness, often accompanied by an increased sensitivity to light.

Dry Eye Syndrome

Dry eye syndrome is characterized by a reduction in the frequency of blinking, which affects the distribution of tears across the cornea. This condition is often exacerbated by focused activities, such as staring at a computer screen for extended periods. Symptoms include a sensation of dryness, grittiness, and soreness.

Management Strategies for Post-LASIK Dry Eyes

The management of post-LASIK dry eyes involves a combination of preventative measures and treatments. While artificial tears and viscous tear gels can provide temporary relief, they do not address the underlying causes of dryness. Patients should be made aware of the potential risks and be encouraged to undergo thorough pre-operative assessments to identify any underlying issues.

Several strategies can be implemented to minimize the risks of dry eyes after LASIK surgery:

Pre-operative Assessment: Thorough evaluation of tear film break-up time and Schirmer's test results can help identify patients at higher risk for dry eyes. Punctal Plugs: Inserting punctal plugs can help retain tears and prevent them from draining. Artificial Tears: Preservative-free artificial tears and viscous gels can be used before bedtime to keep the eyes moisturized overnight. Behavioral Changes: Encourage patients to practice blinking more frequently, especially during extended screen time. Using humidifiers in the home can also help reduce tear evaporation.

In conclusion, while LASIK surgery can pose certain risks, particularly in relation to dry eyes, these risks can be managed and minimized through careful pre-operative assessment and ongoing care. By taking the necessary precautions, patients can enjoy the benefits of improved vision while reducing the likelihood of developing dry eye symptoms.