People with dry eyes lie on a spectrum, ranging from mild cases with intermittent discomfort only when the eyes are ‘overused’, to severe cases with constant widespread corneal erosions causing blurring and pain. Most people with dry eyes lie on the mild end of this spectrum.
An assessment as to whether a patient with dry eyes is suitable for LASIK needs to take into account
- The severity of the dryness
- The reversibility (or not) of this dryness
Generally speaking, if I see a patient with dry eyes severe enough to cause a lot of punctate erosions on the cornea (visible dots that stain with a special fluorescein dye) I advise them to postpone surgery and at the same time treat the dry eye condition aggressively with preservative free artificial tears and possibly punctal plugging. Quite often, after a period of treatment, the dryness improves and the patient then proceeds with surgery.
There are also a lot of patients whose dryness is related to contact lens wear, and just the fact of not having to wear them anymore after LASIK can improve the dry eye condition. Also, some patient’s dryness may be associated with taking medicines like Roaccutane for Acne-and if they stop the medicine, the dry eye condition can improve after some time.
So you might ask, why all this fuss about dry eye and LASIK?
It is well known and pretty much to be expected that LASIK (and for that matter, any other laser refractive surgery including SMILE) causes the eyes to be drier after surgery than before. This increase in dryness is usually temporary, and most patients go back to their original state of eye hydration within about 3 months or so. A small percentage may have increased dryness out to 6 months, and an even smaller percentage (<1%) out to a year or so.
The problem in a patient with pre-existing corneal erosions is that, if their eyes get even drier after LASIK, the erosions can get worse and cause post-operative vision to be blurred. This can sometimes be difficult to manage, even if it is also usually temporary.
Now, everyone is different and I cannot really advise you on whether LASIK surgery is suitable for you because I have not examined you and do not have all the information at hand. If you are still concerned about how dry eyes may affect your suitability for LASIK, I suggest that you discuss this further with your doctor in the first instance.
