Dry Eyes After LASIK: How to Prevent Them and Treat Symptoms

The most common side effect of LASIK eye surgery is dry eye. About 40% of patients report having dry eye one month after surgery. Dry eye after LASIK can affect your vision and cause discomfort. It is not uncommon for patients to have dry eye before LASIK as well. This can increase the chances of experiencing dry eye after LASIK.

This article will cover what causes dry eye after LASIK eye surgery, who is the most at risk for dry eye after LASIK, and common screening tests for dry eye. It also will discuss dry eye treatments.

What About LASIK Causes Dry Eye?

One reason dry eye may occur after LASIK is because of changes made to the eye during surgery. During LASIK, the eye doctor creates a flap in the cornea, which is the dome-shaped area in the front of the eye. Creating this flap may lead to lowered sensitivity in the cornea, particularly in the first three months after surgery. This lowered corneal sensitivity may lead to fewer tears produced in the eye and less blinking, both of which can create more dry eye.

Some people experiencing dry eye after LASIK may have had dry eye that was not diagnosed or fully treated before the surgery. An estimated 38% to 75% of people having LASIK may have dry eye before surgery.

If your dry eye is severe before LASIK and does not respond to treatment, an eye doctor may recommend that you look into alternatives to LASIK to improve your vision. LASIK is contraindicated if severe dry eye is present. 

Is Dry Eye Permanent?

Dry eye after LASIK is not always permanent. In many patients, dry eye symptoms last only about a month. After that time, dry eye signs and symptoms should improve.

About 50% of patients who have had LASIK experience dry eye one week after surgery. This reduces to 40% at one month post-surgery and 20% to 40% at six months post-surgery.

Only about 1% of patients who have had LASIK still experience dry eye one year after the surgery, according to a 2015 study.

LASIK Dry Eye Symptoms

Dry eye that happens before or after LASIK is associated with the same symptoms, including:

• Blurred vision
• A burning feeling in the eyes
• Eye fatigue
• Itchy eyes
• Making too few or too many tears. If your eyes are dry, they may try to produce more tears to make up for the dryness.
• Mucus collecting around the eyes
• Pain or discomfort in windy weather or if you are near circulating air, such as a fan or an air vent

Who Is Most at Risk of Dry Eyes After LASIK?

Although dry eye is a risk for anyone having LASIK eye surgery, there are certain groups of people who are more likely to experience dry eye afterward. They include the following:

• People with more serious nearsightedness before LASIK: Another word for nearsightedness is myopia.
• Being age 50 or over: Tear film changes that happen with age increase your dry eye risk.
• Women who are menopausal: Hormonal changes increase the chance that you will have dry eye.
• Being female: Dry eye affects females twice as often as males, and it's often more severe for females.
• Those who are of Asian descent: An Asian ethnicity is associated with a higher incidence of dry eye.
• Those using certain medications: These include antihistamines and some antidepressants and blood pressure medications. These types of drugs can dry the eyes.
• Where you live: Those who live in dry weather or a dry climate are more likely to experience dry eye.
• Those with an autoimmune disease: These include Sjogren’s syndrome and rheumatoid arthritis. For the most part, patients with autoimmune diseases are not recommended to have LASIK, but it is also possible to find out you have an autoimmune disease after having surgery.
• Those who have diabetes: There may be a higher dry eye risk because of decreased sensation on the cornea.

Screening for Dry Eyes in LASIK Patients

Your eye doctor may use several types of tests to help measure the extent of your dry eye before and after LASIK. Some of the tests used to diagnose dry eye include the following:

• A slit lamp exam: This uses a special microscope called a slit lamp to get a closer look at the eyes.
• Schirmer testing: With this, an eye doctor puts a thin paper strip under the eyes to find out if the eye produces enough tears to keep itself moist.
• Tear breakup time: Also called TBUT, this uses a dye to assess how long the layers of tears stay on your eyes after blinking.
• Tear film staining: Applying a dye to the eye's surface can help reveal areas of damage.
• MMP-9 testing: Short for matrix metalloproteinase-9, this is a type of protein found in the eye that can indicate inflammation. An MMP-9 test helps to assess for dry eye.

In addition to these tests, your eye doctor will ask about your dry eye symptoms. It is also possible to have dry eye without noticeable symptoms.

Treating Dry Eye Before and After LASIK

Although you may find that your dry eye symptoms go away after a couple of months, you can still seek treatment for the time when you have the symptoms.

There are several dry eye treatments available. Your eye doctor may recommend trying different combinations of treatments before finding the right ones for you.

Sometimes, if you aren't completely satisfied with your vision after LASIK, treating dry eye may help your vision to get better.

Here are a few of the medical treatments for dry eye that you may try:

• Lubricating eye drops: Also called artificial tears, these are over-the-counter drops to provide moisture to your eyes. Many eye doctors recommend using preservative-free lubricating eye drops to help avoid preservatives that can irritate the eyes. Preservative-free eye drops are generally more expensive. 
• Eye ointments: These are also available over-the-counter, but they are thicker than eye drops so they coat the eye better. Your eye doctor may advise you to use these at night, as they can make vision blurry.
• Prescription medications that help your eyes make more natural tears: These include medications such as Restasis or Cequa (cyclosporine ophthalmic emulsion) and Xiidra (lifitegrast ophthalmic solution).
• Punctal plugs: These are plugs that an eye doctor will place in your tear ducts to help preserve your natural tears.
• Scleral contact lenses: These are rigid, gas-permeable contacts that can help treat dry eye.
• Autologous serum eye drops: These are eye drops made from a person's blood and mixed with a sterile saline solution. This mix will have certain properties that can benefit the tear film. The eye drops specially produced are closer to natural tears than artificial tears.
• Allergy treatment: Sometimes dry eyes are made worse by other irritants to the eye, such as allergies. If you find your dry eye symptoms get worse around certain allergy triggers, your eye doctor may recommend that you get tested for allergies.
• Talk to your doctor about reviewing medications that you use: It can help you discover if one or more of those medications makes your dry eye worse.

In addition to the medical treatments for dry eye, there are some things you can do at home to help soothe dry eye symptoms:

• Add more moisture to the air with indoor humidifiers.
• Avoid using fans, especially at night.
• Minimize your use of sources that apply heat or wind near the eyes, such as hair dryers or car vents.
• Wear sunglasses outside, especially when it's windy.
• Place warm compresses over the eyes several times a day.
• Make sure you drink enough water.
• Talk to your doctor about the value of using fish oil or flaxseed oil for omega-3 fatty acids. This may help improve dry eye symptoms.

When to See a Doctor

While experiencing dry eye after LASIK is normal, mention your symptoms to your doctor at your follow-up appointment so they can make sure your eyes are healthy. If your signs and symptoms are severe, see your doctor sooner for treatment. If you find you use eye drops more often than your doctor recommends and dry eye symptoms are getting worse, you should also see your eye doctor. Make an appointment if you still have dry eye six months or more after LASIK.

Summary

Dry eye is initially common after LASIK, mostly due to changes made to the eye during surgery. In most patients, dry eye will last only a couple of weeks or months. Although it is hard to fully predict, some patients have risk factors that will make them more likely to experience dry eye. Eye doctors can work with patients to screen for and treat dry eye.

Treatments for dry eye include eye drops, ointments, prescription medications, punctal plugs, and scleral contact lenses. Lifestyle changes such as using a humidifier, drinking more water, limiting exposure to the sun and wind, and consuming omega-3 fatty acids can help.

A Word From Verywell

Dry eye after LASIK may feel uncomfortable. For most people, it is only temporary. Still, you don't need to just live with the discomfort. Let your eye doctor know if you are experiencing dry eye symptoms after LASIK so you can try some of the available treatments.