Dry Eyes after LASIK

Dry eye is the most common complication of LASIK. (1) FDA clinical trials demonstrate 20% of LASIK patient experience worse or significantly worse dry eyes six months after LASIK. (2) Symptoms of post-LASIK dry eye include pain, burning, stinging, and scratchiness. Dry eye after LASIK is due to surgically-induced disruption of processes involved in maintaining a healthy, normal tear film.

The outermost layers of the cornea are densely populated with corneal nerves which signal the brain to activate tear glands. Corneal nerves are severed when the LASIK flap is made. More nerves are destroyed when the laser removes corneal tissue under the flap. Damage to corneal nerves during surgery is most likely responsible for dry eyes after LASIK. Nerve damage results in loss of sensation, so patients with dry eyes after LASIK may not experience pain or burning for weeks or months until sensation returns. Medical studies demonstrate slow, incomplete and sometimes aberrant recovery of corneal nerves after LASIK. (3)

In addition to reduced tear production, patients with dry eyes after LASIK are frequently diagnosed with meibomian gland dysfunction. The meibomian glands found in the eyelids produce the oily component of the tear film. Disruption of flow of these oily secretions results in rapid evaporation of tears. Other factors responsible for post-LASIK dry eyes may include conjunctival goblet cell damage from the suction ring used during LASIK, reduced blink-rate, and decreased tear-clearance.

LASIK-induced dry eyes is treated with a variety of therapies including artificial tears, occlusion of the tear ducts to reduce drainage of tears, prescription eye drops to reduce inflammation and increase tear production, use of moisture chamber goggles, and warm compresses to increase oily secretions. These therapies provide only marginally effective symptomatic relief from LASIK-induced dry eye. There is no cure for post-LASIK dry eye.

  1. Sugar A, Rapuano CJ, Culbertson WW, Huang D, Varley GA, Agapitos PJ, de Luise VP, Koch DD. Laser in situ keratomileusis for myopia and astigmatism: safety and efficacy: a report by the American Academy of Ophthalmology. Ophthalmology. 2002 Jan;109(1):175-87.
  2. Bailey MD, Zadnik K.Outcomes of LASIK for myopia with FDA- approved lasers. Cornea. 2007 Apr;26(3):246-54.
  3. Erie JC, McLaren JW, Hodge DO, Bourne WM. Recovery of corneal subbasal nerve density after PRK and LASIK. Am J Ophthalmol. 2005 Dec;140(6):1059-1064.