Sight is a precious sense because we perceive up to 80% of all impressions by means of our sight. Unfortunately, many of us take your eyesight for granted! 83% of young Singaporean adults are myopic. This is why LASIK surgery is so popular in Singapore.
While LASIK surgery can put an end to your short-sightedness, it also creates new problems such as dry eyes. DoctorxDentist invited Dr Por Yong Ming, an experienced eye surgeon, to share his expert opinions on dry eyes after LASIK through a DoctorxDentist Session.
Disconnected nerve endings are the main cause of dry eyes after LASIK
Dr Por explains that during a LASIK operation, a thin superficial layer of the cornea is created and temporarily peeled back to allow laser treatment of the underlying tissue.
Some of these nerve endings are disconnected during this process, which in turn reduces feedback to your tear glands. This causes your body to produce less tears, which is why your eyes are dry after going through LASIK.
Other factors include changes in corneal shape
The new shape of your corneal may change the way your eyelid interacts with the surface of your eye. This also affects your blinking and tear production.
Dry eyes are usually not caused by complications during the actual LASIK surgery
Dr Por confirms that dry eyes that persist after LASIK surgery generally cannot be attributed to complications during the LASIK surgery.
It's most likely due to pre-existing dry eyes before surgery caused by things such as prolonged contact lens wear, acne medication, and the reasons mentioned above.
It is extremely rare to get dry eyes that do not recover
According to Dr Por, the nerve endings that were disturbed during LASIK typically regrow within several months. After that, you will notice that your eyes are no longer dry.
Most patients experience dry eyes up to 6 months after surgery, and the condition improves out to one year or more.
Punctal plugs are an effective way to keep your eyes moist
Dissolvable punctal plug (Image credit: Review of ophthalmology)
If you have dry eyes (caused by LASIK or not), punctal plugs are great at keeping the moisture in your eyes for a longer time. They also help to reduce the need for eyedrops.
However, if the dryness of your eyes is related to the lack of tear production, punctal plugs will not be effective. Reason being, there are no tears for the plugs to keep around in the first place.
Choose your punctal plugs wisely
Non dissolvable punctal plug (Image credit: Review of ophthalmology)
Dr Por recommends that you avoid silicone plugs. Reason being, they tend to collect mucus and debris around them and often fall out by own their own.
He prefers temporary dissolvable plugs that are inserted into the tear channels, blocking them for a period ranging from about 3-5 months. After which, these plugs disappear by themselves. This minimises the risk of infection.
Unfortunately, this also means that the dryness may return once they are gone.
Punctal cautery is a more permanent solution
If your eyes become dry again after the plugs dissolve, Dr Por recommends a more permanent solution, which is called ‘punctal cautery’.
This uses a special heated probe to permanently shrink and close off the tear drainage channels. It's usually only offered to people who have used the punctal plugs before and found them to be helpful.
Gel or ointment is more suitable for people with dry eyes during sleep
For people with dry eyes that usually manifest during sleep or first thing when you wake, the better solution would be to use a gel or ointment before going to bed.
Gels such as Vidisic or Genteal gel can be used at night for patients whose dryness is most prominent in the middle of the night or first thing on waking in the morning.
These work better than eyedrops (and will last for the whole night) because of it's thicker consistency. Eyedrops are too watery, so they tend to disappear within an hour or so.
Consider thicker eyedrops if you have naturally drier eyes
Dr Por suggests for patients who have drier eyes than usual to use slightly thicker eyedrops such as, Opticlear, Systane Ultra, or Optive Fusion.
The thicker eyedrops may feel a bit sticky but will last longer on the eye so that the drops don’t have to be used as often.
Best ways to ease dry eyes after LASIK
No pain no gain. After LASIK, your eyes will get temporarily drier, especially during the first few weeks. This is a by-product of the procedure, so there's nothing much you can to do prevent this.
However, here are some tips from Dr Por that may help to minimise the effects of dryness on the eye after LASIK:
- Using eyedrops as instructed by your doctor
- Taking frequent regular breaks (every 20 - 30 minutes) from reading/computer use
- Adjusting the air-conditioning in your room so that the air is less cold and less dry
- Making sure you stay hydrated and get enough sleep
You can still go for LASIK even if you have dry eyes
The good news is, regular dry eyes do not negatively affect the outcome of LASIK. Which means to say, your main considerations is just the same as someone without dry eyes.
However, people with severe dry eyes are not suitable for LASIK
One of the problems associated with dry eyes is the development of punctate corneal epithelial erosions (little dry spots on the cornea).
Dr Por explains that if a large number of these develop in the centre of the cornea, your vision will become blurred. In the worst cases, some amount of scarring can also develop.
If you have severe dry eyes that require very intensive treatment, or where it is associated with an underlying systemic disease, most doctors would advise you against laser refractive surgery.
You can treat dry eyes before LASIK surgery
Dry eyes treatment is aimed to minimise or eliminate erosions, as well as to minimise eye irritation and feelings of eye dryness/discomfort.
When there are minimal symptoms, you would be considered for surgery.
Dr Por points out that treatment for dry eyes always starts with frequent artificial tear use. If there's significant inflammation, topical steroids or cyclosporine might be used as well.
Simultaneously, you'd also be asked to stop wearing contact lenses, to treat any contributing eyelid condition such as blepharitis and to take frequent breaks from computer use.
Never ever rub your eyes, LASIK or not!
Dr Por warns that aggressive eye rubbing can lead to other problems.
To find out more, read his full Q&A on dry eyes and LASIK here.
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