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Dry Eyes and Laser Eye Surgery

Dry eyes are one of the most common complications following laser eye surgery so it is important that you understand the risks. Regardless of whether or not you have had laser eye surgery, dry eyes is an extremely common complaint amongst the general population, with studies suggesting about 20%–30% of people will complain about it at some point in their life. Dry eyes are more common in women than men and its prevalence increases as we get older. It is also associated with certain general health problems such as Rheumatoid arthritis and can be aggravated with certain medications.

Put simply, dry eyes occurs when either the quantity or quality (or both) of the tears is not what it should be.

Laser eye surgery and dry eyes

How Can Laser Eye Surgery Cause Dry Eyes?

Laser eye surgery is carried out on the cornea (outer part of your eye) which has a large number of nerves which help detect dryness in your eyes. During Lasik eye surgery these nerves are severed when the corneal flap is created. The deeper the flap, the more the corneal nerves are affected by the surgery. This severing of the corneal nerves causes a decrease in the sensitivity of the cornea and interrupts the flow of information to the entire tearing system. Your lacrimal gland is located just above your eyes and is responsible for producing your tears. It relies on information from these corneal nerves to indicate that the eye is dry. If these nerves are severed during Lasik there will be a period of time when they do not function and consequently cannot send the signal to the lacrimal glands to produce tears.

Generally speaking the shallower the flap the less likely you are to suffer from dry eyes following surgery. For this reason Intralase surgery is often associated with less dry eye problems than standard Lasik, as the flap created is shallower. No flap is created during the Lasek procedure so you are much less likely to get dry eyes following Lasek compared with Lasik surgery. The creation of the flap also causes a change in shape of the cornea which can also affect dryness. You can read more on how Lasik and Lasek differ by reading this guide.

For those people experiencing dry eye problems following surgery, most can expect to see a significant improvement over the 6 months to 1 year following the procedure. During this time the nerves slowly heal and regenerate and hence your dryness reduces. Your laser eye surgeon will most likely give you artificial tears to alleviate the symptoms during this period. Those people who already suffer from dry eye prior to surgery need to be assessed carefully before going ahead with treatment.

Although the vast majority of people do recovery from dry eyes following laser eye surgery, there are some people who will continue to have dry eyes indefinitely. 

Treatment Of Dry Eyes Following Laser Eye Surgery:

There are many different methods that are said to reduce dry eye symptoms and some are more effective than others. What is also true of dry eye treatments is that what may be effective for one person may not be for another. The following gives the main treatments for dry eyes:

  • Artificial tears/gels: This is by far the most common treatment of dry eyes and treats the symptoms rather than the cause. The artificial tears are basically used to substitute your own lack of tears or poor quality of tears.
  • Drink water: Keeping yourself hydrated means your eyes are less likely to be dry. This has varying effects from one person to another.
  • Avoid dry areas: Avoid air conditioned places, heated places or extremely hot / cold weather as all these dehumidify the air. Your tears are much more likely to evaporate when you are in a dehumidified environment.
  • Humidify: Adding a humidifier to your home or place of work can have a dramatic improvement on your dry eye symptoms.
  • Restasis: These are eye drops which contain an anti-inflammatory called cyclosporine. Restasis can help dry eye by reducing inflammation around the tiny channels that carry the mucous, aqueous, and lipids to the eyes. These channels can be shut due to inflammation and when this happens the channels cannot deliver the lubricants necessary for a healthy tear film. Your surgeon will provide you with these if they are considered necessary.
  • Punctal Occlusion: The puncta is the small opening in the corner of your eye by your nose and is where the tears drain away through. They pass through here and down through your nose (naso-lacrimal duct). If your eyes are very dry, blocking the puncta can improve things as the tears are unable to drain away. Initially temporary self-dissolving plugs are used to see if they improve your symptoms. If they have the desired effect then permanent plugs can be inserted.

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