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October 27, 2021 | ICL

What Causes Blurry Vision After ICL Surgery?

By Barrett Eubanks, M.D.

What Causes Blurry Vision After ICL Surgery?

It's normal to have some blurry vision in the first day after ICL surgery. While the recovery with ICL is very quick, it's not instantaneous. There are a few causes that everyone will have as well as a few rare causes which can cause extra blurred vision.

Eye drops used for ICL surgery can cause blurry vision

A whole lot of eye drops are used during ICL surgery. Prior to the surgery, the eye is dilated with dilating drops. Dilation itself can actually cause your vision to blur slightly. Like the aperture of a camera, our eye works best when the pupil of your eye is a certain size. If the pupil dilates past that size, then vision becomes a little more blurry. A dilated pupil exposes more of your natural lens. Light that enters through the periphery of your pupil and then the periphery of your natural lens can focus at a different spot than light that enters through the center of your pupil. This creates something known as spherical aberration. This creates a blur in your vision. It's not a ton of blur and everyone has differing amounts in how much their vision blurs with dilation but it still causes some.

Unfortunately there is nothing you can do to reverse the dilation. There is no eye drop that is capable of reversing dilation. BUT, there is actually medication that can be used in the middle of the surgery. Some surgeons will use this medication at the end of the procedure to reverse dilation. This can work well, but sometimes it can work TOO well and give you a small pupil; again causing blurred vision and trouble seeing in low light (since the pupil can't dilate and allow extra light into the eye) until the medication wears off; which can take two days.

But even if the eye didn't need to be dilated, you will still have some blurry vision from the eye drops and betadine antiseptic used during ICL surgery. On the surface of the cornea is a thin layer of cells called epithelial cells. These cells are like the "skin" on the cornea. Each eye drop causes a small amount of irritation to these epithelial cells on the cornea. As a result, these cells get a little cloudy. One or two cloudy cells would be imperceptible. But when it occurs to a large amount, you can start to get a fog or haze to your vision. Within the first day after ICL surgery, you will have some haziness to your vision due to this reason. Once these epithelial cells heal up (typically after the first night) they become nice and clear again and this haziness goes away. Using artificial tears after the surgery can speed up this process.

So between the dilation and the eye drops used for ICL surgery, you can expect a small amount of blurry vision for the first day after ICL.

But wait, there's more!

There are some rare causes of blurred vision after ICL:

Having a high pressure in the eye can cause blurry vision (see also What Can Be Some Big Problems After ICL Surgery?). Let's revisit the cornea; The cornea has a single layer cells called endothelial cells on the very inside portion of the cornea. These cells have one single job: act as pumps to pump out extra water from the cornea and maintain complete transparency.

Endothelium on bottom of the cornea
Endothelium on bottom of cornea; Image by StemBook (CC BY 3.0) / modified from original

These cells work very well which is why you don't typically need to worry much about them doing their job. But these cells can get overwhelmed when the pressure becomes too high within the eye. Essentially, the high pressure pushes water past these cells to cause the cornea to swell up. When the cornea swells up, it no longer has complete transparency. A swollen cornea will blur and add more fog and haze to your vision. Fortunately, once the pressure is back under control, these cells are able to keep up with the pumping work and the cornea goes back to normal again.

But what if your vision is still blurry beyond those first few days?

Following ICL surgery, it is possible to have some residual prescription error. While ICL surgery is very successful, there will always be a few individuals who for one reason or another ICL couldn't get all of their prescription corrected (see also What Is The Success Rate of ICL Surgery?). Some clues to this being the cases:

  • You can see just fine up close but just have some trouble seeing in the distance —> you may still have a slight amount of near-sighted prescription.
  • Both up close and distance are a little blurry and you notice a small amount shadowing of objects —> you may still have some remaining astigmatism.

Whatever the remaining prescription you have, it can be corrected; a laser eye surgery touch-up (such as lasik or PRK) is frequently an option. If not than a very small glasses or contact lens prescription will be able to take care of the remaining prescription.

Summary

The major causes of blurry vision after ICL isn't really a long list. It typically falls into these three main categories. Eye drops can cause the eye to be dilated and blurry. Eye drops can cause extra cloudiness on the surface of the cornea. Uncommonly, high pressure can cause the cornea to swell and become hazy and lastly, you may have some residual prescription remaining to fix. And fortunately theses causes don't cause any long term changes to vision.

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