LASIK & Dry Eyes

Prescription Treatments Can Help Treat Severe Dry Eyes

• Restasis™ eye drops improve natural tear production. By reducing ocular surface inflammation,
  the tear glands are able to produce natural tears more efficiently
• Steroid eye drops treating inflammation on the ocular surface has been shown to increase tear
  production to improve eye comfort
• Low dose oral doxycycline pills treat any underlying blepharitis and stabilize the tear film.
  At a low dose, doxycycline has anti-inflammatory properties, rather than antibiotic properties,
  to treat rosacea and blepharitis
• Punctual plugs to help tears stay in the eye longer. Eye drops and tears naturally drain through tiny openings located into the inner angle of the eyelids to the nasal passages. Placing tiny plugs
  in each opening, called a puncta, can reduce the drainage of tears away from the eye surface
• Autologous serum eye drops are manufactured by drawing the patient’s own blood and concentrating the serum by centrifugation. Serum eye drops contain natural growth factors and
  immunoglobulins that can heal and nurture the ocular surface. However, these are almost never needed to treat dry eyes after LASIK.

What Other Factors Can Affect Eye Comfort?

• Age. Tear glands become less efficient with age.
• Use of certain medicines. Antihistamines, antidepressants, diuretics, certain blood pressure medicines, and birth control pills can decrease tear production
• Intake of alcohol. The diuretic effect can cause dehydration
• Cigarette smoking. The particulate nature of cigarette smoke can be directly irritating to the eyes, and the chemicals that are inhaled can adversely affect tear secretion and quality
• Hormone changes. It is common for women to notice worsening of dry eye symptoms after menopause.
• Computer Vision Syndrome and blinking frequency. People blink less frequently when they intensely concentrate on a computer, drive or read. This can lead to drying of the eye surface. Right after LASIK, having artificial tears readily available at work, home and in the car can remedy this problem. Remember “20-20-20”, which means taking a 20 second break every 20 minutes and look at least 20 feet in the distance. This will rest and rehydrate your eyes
• Use of sedatives, sleep aids, or muscle relaxants. These all can decrease muscle tension, and can lead to incomplete closure of the eyes during sleep. If the eyes are slightly unclosed, tear evaporation can create significant dry-eye symptoms most notable upon arising in the morning
• Certain make-up products, particularly eyeliners, can affect the lipid tear layer, which is produced on the eyelid margin, and decrease tear break-up time
• Air travel. On commercial aircraft, cabin air is dehumidified and cooled. If travelling by air soon after LASIK, it is advisable to bring and use artificial tears more frequently on the plane
• Use of any vasoconstrictors (Visine, Naphcon-A, Opcon-A) to “get the red out”. Using these drops may temporarily make you eyes look less red, but do not treat the underlying cause of the redness, which is usually dryness.
• Use of tears containing polyvinyl alcohol as the vehicle, which decreases the surface tension of the tears and leads to a less stable tear film.
• External environment & climate can affect eye comfort. Be aware of the impact of breezes from heaters, fans and air conditioners, which cause the tear film to evaporate more quickly.

Proactively Treat Dry Eye before LASIK

Careful preoperative screening can prevent postoperative Dry Eye. A previous history of dry eyes is one of the most important parts of screening evaluation for laser vision correction. Many patients are intolerant of contact lenses because of underlying dry eye. Any symptom of eye irritation, including sandy-gritty irritation, dryness, burning, or foreign body sensation, suggests the possibility of dry eye. Pre-existing dry eye doesn’t necessarily affect the efficacy or safety of LASIK, but it is a risk factor for having Dry Eye after LASIK. If a patient has dry eye symptoms preoperatively, it’s important to maximize the health of the ocular surface prior to surgery.

Consider Alternatives to LASIK

• SMILE LASIK is a potential alternative for patients who are not candidates for LASIK due to dry eyes. Since there is no corneal flap in SMILE LASIK, there is less dryness afterward.  The loss of corneal sensation and post-operative eye dryness is minimized with SMILE LASIK compared with flap-based All-Laser LASIK.
• Visian Implantable Collamer Lens (ICL) can treat a wide range (-3 to -20 diopters) of extreme nearsightedness. The FDA approved the Visian ICL in 2005. The ICL is a lens implant, instead of laser vision correction. It does not cause or worsen dry eyes.

My goal is for patients to achieve excellent vision AND optimum eye comfort. Using this guide as a reference tool, I personalize my specific recommendations to the needs of each patient at my San Jose LASIK office.

References

1. Stern ME, Beuerman RW, Fox RI, et al. The pathology of dry eye: the interaction between the ocular surface and lacrimal glands.Cornea.1998;17:584-9.
2. Kanellopoulos AJ, Pallikaris IG, Donnenfeld ED, et al. Comparison of corneal sensation following photorefractive keratectomy and laser in situ keratomileusis. J Cataract Refract Surg. 1997;23:34-8.
3. Chuck RS, Quiros PA, Perez AC, et al. Corneal sensation after laser in situ keratomileusis.
   J Cataract Refract Surg. 2000;26:337-9.
4. Yu EY, Leung A, Rao S, et al. Effect of laser in situ keratomileusis on tear stability. Ophthalmology. 2000;107:2131-5.
5. Hovanesian JA, Maloney RK. Symptoms of dry eye and recurrent erosion syndrome after refractive surgery.
   J Cataract Refract Surg.2001;27:577-84.
6. Donnenfeld E, Solomon K, Perry H, et al. The effect of hinge position on corneal sensation and dry eye following
   LASIK. Ophthalmology. 2003;110:1023-9.
7. Toda I, Asano-Kato N, Hori-Komai Y, et al. Laser-assisted in situ keratomileusis for patients with dry eye. Arch
   Ophthalmol. 2002;120:1024-8.
8. Campos M, Hertzog L, Garbus JJ, et al. Corneal sensitivity after photorefractive keratectomy. Am J Ophthalmol.
   1992;114:51-4.
9. Litwak S, Zadok D, Garcia-de Quevedo V, et al. Laser-assisted subepithelial keratectomy versus photorefractive
   keratectomy for the correction of myopia. A prospective comparative study. J Cataract Refract Surg. 2002;28:1330-3.