Dry eye is one of the most well known and perhaps one of the most feared complications after lasik. And you probably will get dry eye after lasik. So prepare yourself.
But fortunately, this dry eye is temporary. Most people can expect this dry eye to resolve between one and three months after lasik. A few more can have dry eye symptoms that persist longer. But it is very rare to have significant dry eye a year or more after lasik.
The cause of dry eye after lasik is very well studied. But even then, we learn more about dry eye and the optimal ways to treat and prevent it each year.
To truly understand why we have dry eye after lasik and how long it lasts, lets examine just how lasik causes dry eye.
Lasik Causes Dry Eye
Just beneath the surface of our cornea is a network of nerves. These nerves are important to keep the surface of the cornea from drying out. In particular, they help maintain and regulate the layer of tears that sit on the surface of the eye - called the tear film.
Lasik surgery disrupts all that.
- Creating a lasik flap and doing a laser treatment breaks the connections of these nerves. As a result, these nerves can’t help regulate our tears. We produce less tears and the quality of our tears decrease.
- The lasik suction ring can impair the production of a mucous layer which binds our tears to the cornea.
The end result of all this? The eyes dry out more.
Of note, lasik flaps created with blades created more dry eye than modern lasik flaps using lasers.
The Eye Heals Up
All of this would be very problematic if it weren’t for one key thing: these nerves are capable of regenerating.
As these nerves regrow, the normal balance of the cornea and tear film is restored.
This isn’t the quickest process around. It can take anywhere between 2 to 5 years for the nerves to reach the levels before lasik. But fortunately we don’t have to wait that long for the normal balance of the eye to be restored. For some, the eye is back to “normal" in 3-6 months. For others, depending on age and ethnicity, it may be 6-12 months. (Being older and being of asian ethnicity can make it take longer).
However, this eye being back to “normal" doesn’t always match up to what you actually experience. In fact, even though it can take anywhere between 3 and 12 months for the eye to return back to normal, most people will notice much quicker improvements in actual symptoms of dry eye after lasik.
How Long Dry Eye Lasts
For everyone, the amount and intensity of dry eye will peak between one week and three months after lasik. Afterwards it gradually subsides.
Roughly about 60% will notice dry eye one month out after lasik.
Going even further, a little over a 25% will notice dry eye 3 months out. This decreases down to 20% at 6 months. Most of that dry eye is mild. Less than 5% will have moderate or more dry eye 6 months out after lasik.
When we reach the one year mark after lasik, less than 1% will notice residual dry eye from lasik.
So, if you are like most people, you can expect your dry eye to last about one to three months out after lasik.
Recover Quicker After Lasik
Of course we all want to have as quick of recovery as possible after lasik. Here is what you can do:
Inflammation plays a large role in the development of dry eye. And while lasik primarily has other reasons causing dry eye, inflammation can’t be ignored.
When inflammation builds up on the eye, it impairs the ability of the eye to regulate the tears (sound familiar?). The eye can’t produce tears as effectively & the ability to anchor the tear film to our eye is disrupted. In short, our tear film layer becomes unstable and our eye dries out more.
This drying of the eye causes some microscopic injury which causes MORE inflammation.
This creates a negative cycle of inflammation → worse dry eye → increased inflammation → even worse dry eye → etc
This becomes important both BEFORE and AFTER lasik
- Having uncontrolled chronic dry eye before lasik will make you have WORSE dry eye after lasik. This should make sense. You are adding more dry eye on top of existing dry eye. It’s important to get dry eye under control BEFORE lasik for a smoother quicker recovery.
- Dry eye can’t be ignored after lasik. It’s important to treat the dry eye aggressively to prevent the buildup of inflammation. The eye can’t maintain itself well enough on its own. It needs help from you.
The mainstay of treating dry eye involves frequent use of preservative-free artificial tears. These tears restore our inadequate tear film as well as wash away inflammation from the surface of our eye. Check out These Are The Best Eye Drops After Lasik for a good comparison of the different types.
To complement the artificial tears, omega-3 supplements may be beneficial to encourage the regeneration of the nerves within the cornea and are often recommended.
Rare Exception
There exists a rare and less fully understood type of dry eye that can last longer after lasik which is a little more peculiar called post-lasik neuropathic corneal pain.
Typically dry eye responds to standard dry eye treatments. This type of dry eye doesn’t. Instead of the surface being irritated, the nerves themselves become hyper-sensitized. This often comes with severe symptoms of dry eye, pain and sensitivity despite no appearance that anything is even wrong.
Fortunately, this is rare. This risk of this type of dry eye after lasik is about 1 in a 1000 or less.
This type of dry eye is more difficult to treat. This is partly because this is less fully understood and requires much different types of treatment than standard dry eye.
- Controlling inflammation, as is important with standard dry eye, is again important when the nerves become injured and is a good first step.
- Beyond that, more advanced treatments involve extracting nerve growth factors from the blood to create eye drops. Called serum eye drops, these growth factors help heal and regenerate the damaged nerves and can be a very effective treatment.
- Medications used to treat other disorders of nerves and the brain such as anxiety and depression are also being successfully used.
As this is a rare and more recently described condition, it’s important to find a specialist who understands this type of dry eye and how it is actually treated in order to find relief.
Summary
Lasik will cause dry eye. Everyone can expect some degree of dry eye after lasik. But fortunately this dry eye is short lived. Most individuals can expect to have an increase in dry eye for the first one to three months after lasik. For some, dry eye can last a little bit longer.
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