Dry Eyes After Refractive Surgery
Refractive surgical procedures like LASIK and PRK have become a highly sought-after means of vision correction. These procedures involve surgically reshaping the cornea to improve a patient’s vision.
While refractive surgeries, like LASIK and PRK, are generally considered to be safe and effective and have high patient satisfaction rates, no surgical procedure is without potential risks and side effects. LASIK has been associated with a risk of dry eye during the recovery period.1 PRK is also linked to dry eye side effects during recovery.2
What is Dry Eye?
Dry eye is a condition caused by a lack of tears or poor tear quality, leading to inadequate lubrication of the eyes. Most people associate dry eye with symptoms such as3
● Eyes that sting, burn, or feel scratchy
● Red eyes
● Light sensitivity
● A feeling of grittiness or that there is something in the eyes
● Watery eyes
● Eye fatigue
● Stringy mucus around the eyes or in the eyes
● Discomfort or difficulty wearing contact lenses
● Trouble with night driving
● Blurred vision
Symptoms of dry eye can be uncomfortable, and they can also impede a person’s ability to see clearly when driving at night or when engaging in normal activities. While most people think of dry eye as a nuisance, the truth is that a lack of proper lubrication can increase the risk of eye infections, corneal abrasions, corneal ulcers, and other potentially serious conditions.3
Dry Eye After LASIK
A recent study led by the FDA found that up to 30% of patients who did not previously have dry eye experienced symptoms of dry eye after LASIK eye surgery. The rate of dry eye in LASIK patients who already struggled with that condition was up to 60%.4
So how does LASIK cause dry eye, and is it permanent?
During the LASIK procedure, a blade or laser is used to cut a corneal flap, then the cornea is reshaped to correct refractive errors that lead to blurred vision. The corneal flap is so small that no sutures are needed once the procedure is completed. However, it is believed that during this process some of the nerves of the cornea are cut. This does not affect the patient’s vision, but could interfere with the way the cornea and tear glands communicate, leading to symptoms of dry eye.5
While the majority of LASIK recipients experience only temporary symptoms of dry eye in the first 6-12 months following the procedure (as corneal nerves heal), this becomes a permanent side effect for a small number of patients.6 Most patients who encounter dry eye symptoms following LASIK surgery find relief using over-the-counter lubricating eye drops or artificial tears.
Patients who previously suffered from dry eye, women, and patients who need a high degree of refractive correction are at the highest risk for developing dry eye after LASIK.7
Is There an Alternative?
If you suffer from dry eye disease or have concerns about developing dry eye after LASIK or another surgery, you should know that you might have another option: vision correction surgery with the EVO Visian ICL Lens.
The EVO Visian ICL Lens (Implantable CollamerⓇ Lens) is a different type of refractive procedure, and is often an option for patients at risk for dry eye or who are not candidates for LASIK and other refractive procedures. Unlike procedures that involve surgically reshaping the cornea, the EVO Visian ICL is an artificial lens that is implanted in the eye to correct common refractive errors like nearsightedness (myopia) and nearsightedness with astigmatism.
The EVO Visian ICL lens is made from a biocompatible Collamer that works in harmony with your eye and the EVO Visian ICL procedure does not cause dry eye.8 Most patients enjoy near-immediate vision improvement after the approximately 20-30 minute EVO Visian ICL procedure with 99.4% of EVO patients saying they would have the procedure again.11 Also unlike LASIK and similar refractive procedures, vision correction with EVO Visian ICL is removable , so if your prescription changes or you have additional vision needs, your doctor can remove the lens10
We’re Here to Meet Your Vision Correction Needs
If you are ready to learn more about how you may be able to achieve your best possible vision with refractive surgery, please contact us to schedule a consultation with an experienced eye surgeon. We will help you make an educated decision about which procedure will best meet your needs.
 American Academy of Ophthalmology. LASIK - laser eye surgery. Available: https://www.aao.org/eye-health/treatments/lasik. Accessed March 29, 2021.
2 Shehadeh-Mashor, Raneen MD; Mimouni, Michael MD; Shapira, Yinon MD; Sela, Tzahi BSc; Munzer, Gur LLB; Kaiserman, Igor MD, MSc§, Risk Factors for Dry Eye After Refractive Surgery, Cornea: December 2019 - Volume 38 - Issue 12 - p 1495-1499 doi: 10.1097/ICO.0000000000002152. Available: https://journals.lww.com/corneajrnl/Abstract/2019/12000/Risk_Factors_for_Dry_Eye_After_Refractive_Surgery.4.aspx. Accessed March 29, 2021.
3 Mayo Clinic. Dry eyes. Available: https://www.mayoclinic.org/diseases-conditions/dry-eyes/symptoms-causes/syc-20371863. Accessed March 1, 2021.
4 Eydelman M, Hilmantel G, Tarver ME, et al. Symptoms and Satisfaction of Patients in the Patient-Reported Outcomes With Laser In Situ Keratomileusis (PROWL) Studies. JAMA Ophthalmol. 2017;135(1):13–22. doi:10.1001/jamaophthalmol.2016.4587. Available: https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2587831. Accessed March 1, 2021.
5 Shtein RM. Post-LASIK dry eye. Expert Rev Ophthalmol. 2011;6(5):575-582. doi:10.1586/eop.11.56 Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3235707/. Accessed March 29, 2021.
6 Bower KS, Sia RK, Ryan DS, Mines MJ, Dartt DA. Chronic dry eye in photorefractive keratectomy and laser in situ keratomileusis: Manifestations, incidence, and predictive factors. J Cataract Refract Surg. 2015 Dec;41(12):2624-34. doi: 10.1016/j.jcrs.2015.06.037. PMID: 26796443; PMCID: PMC5702539. Available: https://pubmed.ncbi.nlm.nih.gov/26796443/. Accessed March 29, 2021.
7 Shoja MR, Besharati MR. Dry eye after LASIK for myopia: Incidence and risk factors. Eur J Ophthalmol. 2007 Jan-Feb;17(1):1-6. doi: 10.1177/112067210701700101. PMID: 17294376. Available: https://pubmed.ncbi.nlm.nih.gov/17294376/. Accessed March 1, 2021.
8 Naves, J.S. Carracedo, G. Cacho-Babillo, I. Diadenosine Nucleotid Measurements as Dry-Eye Score in Patients After LASIK and ICL Surgery. Presented at American Society of Cataract and Refractive Surgery (ASCRS) 2012.
9 Packer M. The Implantable Collamer Lens with a central port: review of the literature. Clinical Ophthalmology. 2018: 12: 2427–2438.
10 Staar Surgical. Visian ICL Patient Information Booklet. Available: https://us.discovericl.com/. Accessed March 1, 2021.
Important Safety Information
The Visian ICL and EVO Visian ICL lens is intended to correct/reduce nearsightedness between -3.0 up to -20.0 D and treat astigmatism from 1.0 D to 4.0 D. If you have nearsightedness within these ranges, Visian ICL and EVO Visian ICL surgery may improve your distance vision without eyeglasses or contact lenses. Because the Visian ICL and EVO Visian ICL corrects for distance vision, it does not eliminate the need for reading glasses, you may require them at some point, even if you have never worn them before. Since implantation of the Visian ICL and EVO Visian ICL is a surgical procedure, before considering Visian ICL and EVO Visian ICL surgery you should have a complete eye examination and talk with your eye care professional about Visian ICL and EVO Visian ICL surgery, especially the potential benefits, risks, and complications. You should discuss the time needed for healing after surgery. Complications, although rare, may include need for additional surgical procedures, inflammation, loss of cells from the back surface of the cornea, increase in eye pressure, and cataracts. You should NOT have Visian ICL and EVO Visian ICL surgery if your doctor determines that 1) the shape of your eye is not appropriate, 2) you do not meet the minimum endothelial cell density for your age at the time of implantation, or 3) your vision is not stable; or if you are pregnant or nursing.