Dry Eye Symptoms After LASIK Surgery
Approximately 35% of patients develop dry eye symptoms at 3 months after LASIK surgery, with roughly 25% of those without preoperative dry eye symptoms developing new symptoms postoperatively. 1
Prevalence and Timeline
The incidence of dry eye after LASIK varies significantly depending on the timepoint measured and the population studied:
Short-term (Early Postoperative Period)
- At 1 week post-LASIK: Approximately 47-53% of patients experience dry eye symptoms 2
- At 1 month: The prevalence decreases to approximately 38-41% 2
- At 3 months: The most robust data from the FDA's PROWL studies show approximately 35% prevalence of dry eye symptoms 1
Long-term (Chronic Dry Eye)
- At 6 months or beyond: Chronic dry eye persists in approximately 20% of patients who were asymptomatic before surgery 3
- Some studies report persistent symptoms in 20-55% of patients at 6 months or more, though this wide range reflects differences in diagnostic criteria and patient populations 4
New-Onset Symptoms
Critically, approximately 25% of patients without any preoperative dry eye symptoms will develop new dry eye symptoms at 3 months post-LASIK 1. This represents a substantial risk for previously asymptomatic individuals.
Risk Factors for Post-LASIK Dry Eye
The following factors significantly increase the risk of developing chronic dry eye after LASIK:
- Female sex - Women have significantly higher risk 3
- Higher degree of myopic correction - Greater refractive error correlates with increased dry eye risk 3, 2
- Greater ablation depth - Deeper laser treatment increases risk 3, 2
- Combined ablation depth and flap thickness - Total tissue disruption matters 2
- Preexisting dry eye - Patients with any baseline dry eye are at substantially higher risk for severe postoperative symptoms 1, 5
Clinical Implications and Counseling
All patients considering LASIK, particularly those with preexisting dry eye, must be counseled that keratorefractive surgery may worsen their dry eye condition 1. The American Academy of Ophthalmology guidelines explicitly state that uncontrolled dry eye disease is a contraindication for keratorefractive surgery 1.
Preoperative Management
- Effective treatment for dry eye should be achieved before undergoing keratorefractive surgery 1
- Optimization with artificial tears, nutritional supplementation, punctal occlusion, and topical cyclosporine A in symptomatic patients decreases the incidence of severe postoperative symptoms 5
Natural History
Dry eye symptoms are most common in the first few months after surgery and tend to subside with time 1. However, a significant minority (approximately 20%) will have persistent symptoms beyond 6 months 3.
Common Pitfall
A critical caveat is that approximately 25% of patients with poor reflex tear flow (Schirmer's test ≤5 mm) are not clinically diagnosed with overt dry eye syndrome preoperatively 6. These "Pre-DES" patients frequently require postoperative lubricant medications and represent an at-risk population that may be underrecognized during preoperative screening 6.