Study: LASIK dry eye

Truth be told... I've always had a little bit of a grudge against this journal because although it is dedicated exclusively to refractive surgery, it rarely talks about dry eye - which just happens to be the #1 side effect of laser refractive surgery.

But today, hats off and grudges begone. Wow! Thank you for acknowledging what so badly needs to be said.

Now if we could just get this included in every LASIK informed consent form.

My only reservation/criticism about this abstract is that some use this kind of thing to justify what amounts to temporarily suppressing a chronic ocular surface problem in order to justify LASIK on a high risk candidate. Even that might not be as much of a problem as it is were it not that ocular surface diseases are so frequently misdiagnosed and undertreated (see my article on diagnosis.

LASIK-associated Dry Eye and Neurotrophic Epitheliopathy: Pathophysiology and Strategies for Prevention and Treatment
Renato Ambrósio Jr, MD, PhD; Timo Tervo, MD; Steven E. Wilson, MD
Journal of Refractive Surgery Vol. 24 No. 4 April 2008

PURPOSE
To review the pathophysiology of LASIK-associated dry eye conditions and provide insights into prophylaxis to decrease the incidence of dry eye after LASIK and to treat the condition when it occurs.

METHODS
A review of the literature was performed on LASIK-associated dry eye and the experience of the authors was summarized.

RESULTS
LASIK has a neurotrophic effect on the cornea, along with other changes in corneal shape, that affect tear dynamics causing ocular surface desiccation. Dry eye is one of the most common complications of LASIK surgery. Symptoms of dryness may occur in more than 50% of patients, with other complications such as fluctuating vision, decreased best spectacle-corrected visiual acuity, and severe discomfort occurring in approximately 10% of patients. Preoperative dry eye condition is a major risk factor for more severe dry eye after surgery and should be identified prior to surgery. Optimization with artificial tears, nutrition supplementation, punctal occlusion, and topical cyclosporine A in patients with symptoms or signs of dry eye prior to LASIK decreases the incidence of more bothersome symptoms following surgery. Patients with LASIK-induced neurotrophic epitheliopathy often respond to topical cyclosporine A treatment, which treats the underlying inflammation and may benefit nerve regeneration.

CONCLUSIONS
LASIK-induced dry eye and neurotrophic epitheliopathy are common complications of LASIK surgery. Optimization of the ocular surface prior to surgery decreases the incidence and severity of postoperative symptoms of the condition.