One of the most common complications of LASIK is dry eye with virtually all patients developing some degree of dryness immediately post-surgery and in many cases lasting for years after. There is no way to predict the severity of post-LASIK dryness for any individual patient.
Post-LASIK dry eyes is actually a disease of the tears, the oil (meibomian) producing glands and the ocular surface. The resulting symptoms are ocular discomfort, visual disturbance and tear film instability with potential damage to the ocular surface. Post-LASIK dry eye is almost always accompanied by inflammation of the ocular surface. It can be caused by either inadequate tear production or excessive tear evaporation. The dry eye symptoms range from mild ocular irritation to severe discomfort, photophobia (severe light sensitivity), corneal scarring and vision loss. Approximately 95% of post-refractive surgical patients experience dry eye symptoms. Most of the patients who do experience severe dry eye symptoms do not get relief from traditional dry eye treatments.
Quality of life can be severely affected by post-LASIK dry eye. Two independent retrospective studies of patients suffering from severe dry eye show disability comparisons to those suffering from moderate to severe angina or hospital dialysis.
The causes of post-LASIK dry eye are complex and multifactorial. The ocular surface, tear gland and oil producing glands all work together to maintain a stable ocular surface environment. The corneal nerves of the ocular surface and of the deeper corneal tissues are severed during the LASIK surgery. This disrupts the delicate relationship between the ocular surface and the pre-corneal tear film. The disruption of this relationship leads to tear dysfunction and causes inflammation of the corneal surface along with loss of surface corneal tissue and in some cases corneal scarring and vision loss.The best treatment option for patients experiencing severe dry eye are scleral lenses. Gas permeable scleral lenses have been shown to be extremely effective in providing relief from post-LASIK dry eye and for restoring quality vision. The reason that scleral lenses work so well in treating a severely dry eye is quite simple: The scleral lens that we design keeps the compromised dry cornea in a moist liquid environment at all times. These unique lenses vault over the dry cornea and are supported by the white portion (the sclera) of the eye. A liquid reservoir exists between the back surface of the lens and the front surface of the eye. We design our scleral lenses with the use of special computers and proprietary software in a unique manner for each individual eye. Our lenses in effect replace the cornea as an optical surface. What this means is that besides effectively treating the dry eye, visual distortions and higher order aberrations are eliminated and clear stable vision is restored.
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This is a photo of a post-LASIK dry cornea. The dark “blotchy” areas inside and outside the treated LASIK zone represent areas on the corneal surface devoid of moisture.
This eye underwent LASIK surgery several years prior to the taking of this photo. The small green-yellow dotes seen on the surface of the cornea represent clusters of corneal tissue that are no longer living due to ocular surface disease and inflammation.
This photo is of a post-LASIK cornea that is cloudy, dry and has ectasia. This eye has a scleral lens over the corneal surface. The front surface of the eye (the cornea) is in a liquid environment at all times. The lens is not touching the compromised corneal tissue. Vision and comfort is excellent.
This eye developed its cloudy appearance several years after undergoing LASIK. Note the dry, dull appearance of the ocular surface.
This eye underwent 2 separate LASIK procedures. The second procedure was called an “enhancement” but in reality is just another LASIK surgery. Note the darker “blotchy” areas just below the pupil. These are dry areas on the corneal surface. This eye has extremely irregular surface. Patient is now wearing a scleral lens on this eye and is enjoying clear, comfortable undistorted vision.