Dry Eye After LASIK

Abstract

Post-LASIK dry eye is the most common postoperative dry eye after ophthalmic surgeries. The clinical signs of post-LASIK dry eye include positive vital staining of the ocular surface, decreased tear breakup time and Schirmer test values, reduced corneal sensitivity, and decreased functional visual acuity. The symptoms and signs usually last for about 1 month after LASIK. A small number of patients continue to experience symptoms more than 1 year postoperatively. It has been suggested that the loss of corneal innervation caused by flapmaking is the major cause, affecting the corneal-lacrimal gland, corneal-blinking, and blinkingmeibomian gland reflexes, resulting in decreased aqueous and lipid tear secretion and mucin expression. A new type of corneal refractive surgery, SMILE, which has less impact on corneal nerves, induces less postoperative dry eye, supporting the association between corneal denervation and postoperative dry eye. As LASIK enhancement by flap-lifting induces fewer dry eye symptoms and signs than initial surgery, factors other than neurotrophic effects may be involved in the mechanisms of post-LASIK dry eye. Post-LASIK ocular surface pain is a type of postoperative chronic pain and discomfort, and is thought to be a different clinical entity from dry eye, possibly induced by abnormal reinnervation or neural sensitization of peripheral nerves and the central nervous system after LASIK. Treatments include tear supplements, anti-inflammatory agents, meibomian gland dysfunction management, ointment and eye patches, punctal plugs, and autologous serum eye drops. For patients with preoperative dry eye, careful patient selection, and preoperative ocular surface management are mandatory.

Subjective Happiness and Satisfaction in Postoperative Anisometropic Patients after Refractive Surgery for Myopia

“…Aged eyes may suffer dry eye symptoms, which is more prevalent in older populations [38,39], and a common pathology of decreased visual function with increased aberration and increased scattering originally induced by tear film instability on the ocular surface [40,41]. Dry eye symptoms may be newly developed after LASIK [42], and the loss of corneal innervation caused by flap making has been suggested as the major cause, affecting the corneal-lacrimal gland, corneal-blinking, and blinking meibomian gland reflexes, resulting in decreased aqueous and lipid tear secretion and mucin expression. Dry eye measurements, including the Schirmer test, conjunctivocorneal staining, tear film break-up time, as well as dry eye symptoms, should be evaluated in future studies.…”

Relationship between lipid layer thickness, incomplete blinking rate and tear film instability in patients with different myopia degrees after small-incision lenticule extraction

“…Dry eye disease (DED) presents a multifactorial pathology at the ocular surface, including tear film changes with or without corneal damage, ocular symptoms, visual degradation, and increased tear osmolarity, which together lead to a reduction in quality of life [1]. DED is the most common complication of corneal refractive surgery [2,3] and is the main cause of refractive regression, decline in vision quality, and decreased patient satisfaction [4][5][6].…”

Clinical Outcomes of SMILE and FS-LASIK Used to Treat Myopia: A Meta-analysis

“…reation of a corneal flap and ablation of the stroma during LASIK temporarily damages nerves, reducing corneal sensitivity, tear film stability, and tear secretion. 1,2 Femtosecond lasers afford many advantages compared to microkeratomes, including excellent precision and control of flap diameter and thickness. Thus, flap-related complications and epithelial injuries are reduced, and corneal sensitivity recovers faster.…”