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Laser eye surgery is a popular vision correction procedure for people looking for the convenience of daily life without glasses and contact lenses. There are two main types of vision correction using refractive excimer laser technology: LASIK, or laser-assisted intrastromal keratoplasty, and PRK, or photorefractive keratectomy. LASIK has become the most well-known, likely due to a better marketing acronym, but both types have advantages and disadvantages.
The LASIK procedure requires cutting a flap in the eye before shaping the cornea with the excimer laser. The flap is placed back over the cornea. PRK surgery does not require cutting of the eye; the epithelium layer of the eye is brushed away and the cornea is reshaped with the excimer laser to correct vision. Both types of refractive surgery have side effects such as dryness, poor night vision and seeing glare or halos.
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Dry Eyes Caused by Laser Refractive Surgery
No surgery is without risks, and even a seemingly minor side effect such as dry eyes can cause discomfort and pain. Dry eyes are common side effects for up to two months after refractive laser eye surgery and, in most individuals, this condition improves over time. This severe side effect seems to be more common in individuals who undergo the LASIK procedure. This may occur due to the formation of the flap, which severs corneal nerve fibers and causes dry eye syndrome.
The cornea of the eye contains densely innervated tissue and cutting a flap in any part of the cornea will sever sensory nerves that may not regenerate properly or at all. This causes inadequate volume or composition of natural eye tear production. Eye nerve damage may also occur in PRK procedures during laser reshaping of the cornea. Severe and chronic dry eyes for longer than 12 months after the procedure occur very rarely.
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Severe Dry Eyes Can Be Treated With Drops and Punctal Plugs
Dry eyes caused by refractive surgery can be treated with intensive eye drop therapy. If this condition is permanent, artificial eye tears have to be used permanently, as there is no cure. In severe cases, where dry eyes cannot be relieved by artificial tears or ointments, a procedure called punctal plugs blocks eye tears from draining. The puncta are the opening of the tear ducts that exit into the nose. This procedure can help alleviate severe dry eyes by preventing tears from draining too quickly.
Patients with naturally dry eyes are at higher risk of complications from refractive laser eye procedures. Other causes of dry eyes include medications such as anticholinergic drugs and disorders such as diabetes, autoimmune disease and rosacea. The LASIK procedure is also not recommended for individuals under the age of 20 years, pregnant women and patients with a history of eye disease such as optic nerve damage, glaucoma or cataracts. An ophthalmologist (eye specialist) will determine if a patient is a good candidate for refractive laser eye surgery before the procedure.