LASIK and Dry Eyes

| Jul 06, 2010 | Comments 2

Anne asked:

Hi Dave,
I’ve come across a lot of comments from lasik patients re: dry eyes. Many of these did not suffer with dry eyes prior to surgery. Can this become a long-term issue as many people say they are still experiencing dry eyes 6 months down the line? Also, is it something that can be avoided through the laser used and surgeon’s experience/ability? I know that you say patients do not experience TLS with the Ziemer laser, so can the same be said of dry eyes?
You mentioned in one of your previous replies that there was someone in the Cheshire area I could go to for a consultation (with a view to having surgery with Focus), please could I have their contact details?
Many thanks, Anne

Hi Anne,
A temporary reduction in tears following LASIK happens in all cases, although many are unaware of it. It happens because the superficial corneal nerves are cut during flap creation. The cornea becomes number and the nerves have to re-grow to supply the surface with normal sensation. This takes 3-6 months with a thin femtosecond flap, longer with a thicker blade flap.

The thinner the flap, the less distance to re-grow and so the sooner the cornea returns to normal. So having patients report still having dryness at 6 months is not unusual, especially if they had a thicker flap.

In some cases of ongoing dry eye, there can have been some pre-existing deficit in the tear film or tear quality that gets exacerbated by the temporary numbness in the cornea and other factors (e.g. loss of goblet cells).

I find ongoing dryness is rare in my clinic, and I think that is because we are rigorous in diagnosing, and treating where needed, prior to surgery. Technology cannot avoid the creation of some dryness (whether symptomatic or not). However creating a thin flap with a femtosecond laser makes for less dryness of shorter duration.

But it is the skill of the surgeon and clinical team that heads of problems before they are created, by not operating on patients who may lead to later trouble. Patients with marked dry eye should not have LASIK. Some dryness though can be managed and treated pre-op and so allow those patients to still be eligible for LASIK and without long-term problems.

Anne, call one of my team on 0845 5000 500 and we can connect you with our optometrist in Cheshire for an assessment.

»crosslinked«

Filed Under: LASIK • Questions • Safety

Tags: • • • • •

About the Author: Mr. Dave Allamby FRCS FRCOphth is a leading London-based laser eye surgeon. You may have seen him on the This Morning TV show with Phillip Schofield and Fern Britton or read one of several articles in the national press, recently for treating Denise Van Outen, rock giant Rick Wakeman and broadcaster Paul Ross. David is Medical Director at Focus Laser Vision, known as a world-leading clinic in the treatment of presbyopia, or age related loss of close vision. Focus Laser Vision is also London's only clinic to offer next-generation Z-LASIK laser eye treatment for short sight, long sight or astigmatism.

RSSComments (2)

Leave a Reply | Trackback URL

  1. William says:
    July 4, 2011 at 11:39 pm

    Dear Dave,

    As far as I know, even with the newest technology that create flaps <100 microns there are still cases of permanent dry eye, which obviously has a very severe effect on someone's life. It seems that in those cases, pre-op tests for dry eye did not flag such issues as it does not necessarily correlate with such test values.

    Would you say that for someone who would like to reduce the risk of permanent dry eye to the absolute minimum, Lasek/PRK is the better choice as it cuts less stromal tissue and has therefore lower risk of permanent dry eye?

    I feel like I could be ok with all other risks (even if they occur at very low probabilities) but NOT permanent dry eye.

    Many Thanks

    Reply
    • Dave Allamby says:
      July 7, 2011 at 12:53 pm

      Hi William
      I don’t see permanent dry eyes in those patients who had a good tear film pre-operatively. At my clinic, we are very aggressive in testing for, and treating pre-operatively as necessary, any eye dryness. I prefer thin-flap LASIK, as there is less inflammation post-operatively when compared with PRK/LASEK, (inflammation is a key component of symptomatic dry eye) and a fairly quick recovery of corneal nerve supply. The important stage is to be able to say no to someone with significant dry eye ad who does not respond to appropriate therapy.
      Regards, Dave

      Reply

Leave a Reply

Rss Feed Technorati button Reddit button Myspace button Linkedin button Delicious button Digg button Stumbleupon button Flickr button Facebook button Tweeter button Youtube button