Is LASIK still suitable for me if I have dry and sensitive eyes? Will it cause even worse dryness?

Current options available for laser vision correction include corneal flap-based procedures like LASIK, and also no flap, Advanced Surface Ablation (ASA) methods like TransPRK.

During LASIK, the doctor will have to cut your cornea to create an external flap using either a blade or a Femtosecond laser (bladeless LASIK). Whether using a blade or the laser, there will still be a cut corneal flap and this will result in cut corneal nerve endings, increasing the risk of procedure-induced dry eyes. This, together with flap complications, are the main disadvantages of LASIK.

For TransPRK, the procedure is surface-based, with no cut flap. Scientific studies have shown that Advanced Surface Ablation laser vision correction procedures like TransPRK have a lower incidence and low severity of dry eye complications.

In any case, in view of your dry eyes history, you will need to see your ophthalmologist to do a comprehensive evaluation of your eyes before going for any laser vision correction procedure.

Yes, LASIK does usually make dry eye symptoms worse. However, you may still be able to have LASIK done if you can have your dry eyes assessed and treated adequately before your LASIK procedure.

My advice would be to:

1. Have your dry eyes assessed and treated well to a stage of minimal to no symptoms.
2. Be aware that LASIK may worsen your dry eye symptoms, hopefully only temporarily.
3. Immediately after your LASIK procedure, treat your dry eyes aggressively to prevent symptoms from appearing. Don’t wait for symptoms to appear before starting to treat them!
4. Be conscientious about using your eyedrops. Use them frequently and regularly, even if you don’t feel you need them.

Recently, I wrote about a few methods to treat dry eyes effectively. You may want to try out some of these methods for dry eyes before and after LASIK.

Dry eyes (especially if mild) can be treated and managed properly, hence it definitely does not disqualify you from LASIK.

I hope that was helpful to you.

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

1. The severity of the dryness
2. 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.

With all things relating to surgery, risks of side effects and complications are important considerations. One known important side effect of LASIK surgery is that of dry eye syndrome.

Part of the assessment of whether a person is suitable for LASIK is to look out for signs of pre-existing severe dry eyes which may effect the patient via a poor corneal surface resulting in transient blurring of vision and discomfort by way of foreign body sensation over the eyes.

In addition, it is important to identify the causes of dry eyes which may either be reversible or irreversible. Patients who exhibit severe irreversible dry eye syndrome, that is resistant to treatment, are generally discouraged from having LASIK. Some forms of dry eye syndrome may be related to reversible causes like contact lens overuse and intolerance. In these particular cases, a period of treatment and abstinence from contact lens may allow the patient to regain healthy moisturisation of the cornea. Should the cornea return to good health, the patient is then able to safely undergo LASIK surgery.

In relation to your own situation, it would be best to have a discussion about your concerns with your eye surgeon. I’m sure he will be happy to listen and explain to you what his thoughts are about the potential risks involved in your case. One could also consider alternative forms of laser treatments like Advanced Surface Ablation and ReLEx SMILE which potentially have lower risks of dry eyes compared to LASIK.

Your surgeon would consider all options and advise on the best course of action. I hope this demonstrates an important point that there really is no such thing as one “best” treatment rather it is more appropriate to find the treatment that best suits your eyes. Hope you have a happy outcome from your search for spectacle independence.