Ask Dr Por Yong Ming: Dry Eyes & LASIK

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.

Which eye drop is best depends on the situation. After LASIK, all patients are routinely given preservative free artificial tears such as Tears Naturale Free or Refresh Plus. Relatively liquid preparations such as these are usually used first as they feel comfortable and ‘refreshing’ when applied. However, being very liquid and runny, if the dryness is more intense than usual a patient may feel they have to use these drops very often.

Punctal plugs are very effective for treating dry eyes, whether or not the problem is associated with LASIK. However, it is important to note that punctal plugs work by keeping whatever moisture is already on the eye (whether naturally produced or from eyedrops) around for a longer time, instead of allowing them to drain away into the nose. Therefore, it does not help the dryness that some people get while sleeping-and which they may experience on waking in the middle of the night or first thing in the morning.

Most patient’s eyes will get a bit drier in the time just after LASIK (first few weeks), and this is related to the surgery. Ie you cannot influence this aspect of it that much.

All kinds of laser refractive surgery, whether surface ablation (PRK/TransPRK/epiLASIK/LASEK-they are all the same), LASIK or ReLEx SMILE will induce some amount of post-operative dry eyes. However, if you look purely at the disturbance to the corneal nerve endings and how long they may take to regenerate, it is likely that the problem is least with surface ablation, then SMILE, and then LASIK. There are also some studies which show that the degree of post-operative dryness is less with SMILE compared with LASIK. However, consider this: Dry eyes span a spectrum from mild-moderate-severe.