If you learn one precaution after lasik, learn to avoid rubbing the eyes. But sometimes you can't help it and you accidentally rub your eye. Here's what you should look out for as well as a background on what rubbing can actually do.
Why are we concerned about rubbing the eyes after lasik?
The biggest reason rubbing is an issue after lasik is that rubbing can cause a flap dislocation after lasik.
During lasik surgery, a flap is created just below the surface of the cornea. For lasik to work, the treatment needs to be applied to the rigid part of the cornea, called the stroma. This allows for the cornea to be remodeled and vision corrected. The creation of a lasik flap allows for quick access to the stroma. The lasik flap is simply folded back and the lasik treatment applied. Afterwards this lasik flap is repositioned in the exact same place that it came from. The flap allows for a quick recovery after lasik. But rubbing can cause the lasik flap to shift out of position.
How to tell if you have a lasik flap dislocation
There are two main things you will notice if you accidentally cause a lasik flap dislocation:
The first thing you will notice is pain. The cornea is one of the most sensitive parts of the body. That's why it's painful or uncomfortable to touch your eye (NOT recommended to try).
The very surface of the eye is covered by layer of cells called the epithelium. Underneath this layer, the cornea is even more sensitive. Typically the epithelium and lasik flap cover this layer to prevent us from being in pain. For the first few hours after lasik, you notice some of this pain and discomfort from the gap between the lasik flap and the rest of the cornea. As that gap heals over, this pain goes away.
So if the lasik flap becomes displaced or dislocated after accidentally rubbing the eyes, you suddenly have a much larger gap between the edge of the lasik flap. You will have a sudden increase in pain. This pain may be more uncomfortable than what you felt during the initial first few hours after lasik. This pain will gradually go away, however, it will just take longer. It will take a few days for the pain to subside as the epithelium grows back over that gap to protect the cornea once again.
But in addition to pain, you most likely will have some blurred vision. When the lasik flap is shifted out of position, it will frequently fold up on itself (there is just simply too much friction for the whole lasik flap to slide if it is rubbed). This creates a wrinkle or fold in the lasik flap. If this fold is directly in the center of your vision, it will create some distortions and blur your vision. But even if this wrinkle is just outside of your vision, it can still cause extra prescription, such as astigmatism, to your vision and result in blurred vision. When the pain goes away, this blurred vision will remain until the flap dislocation is fixed.
What do you need to do if you have a flap dislocation
If you accidentally rubbed your eyes and your vision is good and the eye feels the same, then chances are nothing is wrong. But if you have a concern, then it's always a good idea to call your surgeon's office to double check.
If you did develop pain and / or blurred vision after accidentally rubbing the eyes, then you will definitely want to get scheduled to get it looked at. In the office, they can definitively determine if there is a flap dislocation.
If you have a flap dislocation, it will need to be fixed. Your surgeon may want to fix the flap dislocation the same day (especially if the dislocation occurs very early on in the recovery) or your surgeon may schedule the fix in the near future.
Flap dislocations are fixed through a procedure called a "refloat". During the procedure, the surgeon folds back the lasik flap, removes the extra healed epithelium and uses sterile water to float the lasik flap back into position. Afterwards, the lasik flap is inspected to confirm that there is not any residual epithelium underneath the lasik flap.
The recovery afterwards is very similar to how the eye recovers after the initial lasik procedure. You may have blurred vision for a little bit longer. You may have just a little bit more scratchiness. Both of these two things will still heal up pretty quickly.
Occasionally during a re-float procedure, the surgeon must remove the epithelium directly on top of the fold in the lasik flap. For flap dislocations that are caught later, the epithelium can "fill in" the valley of the fold in the lasik flap and prevent the lasik flap from being fully ironed out. By removing this epithelium, the surgeon will then be able to fully expand the lasik flap out to its full size and remove the wrinkle. If this is required, this will extend the recovery time. The vision will be blurry and the eye will feel more irritable and scratchy until the epithelium heals over. This can take anywhere between 1-4 additional days depending on how much epithelium needed to be removed.
How common does rubbing cause a problem
Fortunately, flap dislocations are rare. If you accidentally rub your eye, the probability of you causing your lasik flap to dislodge out of position is very low. The exception is within the first day after lasik and especially within the first few hours.
During the first few hours, before the gap between the lasik flap and the rest of the cornea has healed over, the lasik flap is at its weakest. Rubbing the eye will more than likely cause the lasik flap to dislocate. It is only after the epithelium heals up this gap that the flap starts to become more secure on the surface of the eye. Thus the greatest risk of rubbing the eye is within the first few hours after lasik (however, this does NOT give you a green light to rub your eyes once you are past this timeframe). Gradually over time, as the lasik flap strengthens, accidentally rubbing the eye becomes less and less of an issue until eventually it becomes hard for you to actually cause a problem by rubbing the eyes (but still best NOT to try).
How to prevent accidentally rubbing the eye
The trick is to prevent something from accidentally happening. Because you can't predict when you will accidentally rub your eyes, you have to take precautions to prevent it from happening.
Eye protection
Going home from surgery, frequently you wear large "fashionable" goggles or sunglasses. Wearing goggles or glasses or eye shields over your eyes provide a barrier to you accidentally reaching up to rub your eyes. Thus after lasik, as per your surgeon's instructions, you will want to wear that eye protection - typically during the first few hours after lasik.
Another common way you can accidentally rub the eye is while sleeping. You may not even realize what you are doing at the time since you will be asleep. To prevent you from causing issues while sleeping, it is very common for you to wear the eye shields or goggles for the first few days after lasik just to provide some protection from accidental rubbing over night.
Prevent triggers to rub the eyes
If you have eye irritation or itchiness, you may have the urge to rub your eyes to help soothe the irritation. It can be very hard to control this urge. Thus, preventing those triggers of eye irritation or itchiness can be an easier way to prevent accidentally rubbing of the eyes. It's normal to have some irritation after lasik. Because of this, frequent use of preservative free artificial tears are recommended. Artificial tears help replenish tears and wash away excess inflammation on the surface of the eye to help with the irritation after lasik. If itchiness is the main problem, that can frequently be a sign of allergies. Using over the counter anti-histamine eye drops can help calm down the allergies and get rid of the itchy eyes. Getting rid of the symptoms of itchy and / or irritated eyes can reduce your urge to rub your eyes after lasik.
Summary
The good news is that if you accidentally rub your eyes after lasik, there is a low chance of you causing a problem. Except if you are within the first 24 hours; the chance becomes much higher. But as always, you should check with your surgeon if you have a concern about a flap dislocation after rubbing your eyes. That way if you did happen to cause an issue, they can fix it promptly and get you back enjoying your newly corrected eyes.
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