Corneal Refractive Surgery-related Dry Eye

Risk Factors and Management

Louis Tong; Yang Zhao; Ryan Lee


Expert Rev Ophthalmol. 2013;8(6):561-575. 

In This Article

Abstract and Introduction


Dry eye is the most common post-operative complication in patients who undergo laser-assisted in situ keratomileusis and other photorefractive procedures. Epidemiological studies have found that almost all patients experience some form of dry-eye-related discomfort in the post-operative period. This review seeks primarily to identify patient factors, which predispose to this complication, as well as outline the possible interventions clinicians can consider to avoid, prevent and treat this complication. Numerous pre-, intra- and post-operative guidelines are provided. The ideal method of post-laser-assisted in situ keratomileusis dry eye prevention is a meticulous peri-operative management plan, as opposed to post-operative management alone. Newer modalities of photorefractive surgery may have differing effects on the ocular surface.


Dry eye disease is defined as a multifactorial disease of the ocular surface and tear film that results in symptoms of discomfort, visual disturbance and tear film instability. It is characterized by hyperosmolarity of the tear film and inflammation of the ocular surface.[1]

Photorefractive surgery induces dry eye or exacerbates pre-existing dry eye by causing increased tear osmolarity and inflammation of the ocular surface via various mechanisms.[2] The three predominant techniques of photorefractive surgery now used in clinical practice are laser-assisted in-situ keratomileusis (LASIK), photorefractive keratectomy (PRK) and laser epithelial keratomileusis (LASEK). LASIK continues to be the most commonly performed surgery of the three.[3] This discussion is hence centered upon LASIK, but still includes a study of some recent variants of laser corneal refractive procedures. While it is acknowledged that this topic has been extensively reviewed previously,[4] this article focuses on providing concise, evidence-based guidelines to clinicians on how best to prevent or treat post-LASIK dry eye. This begins from a process of prudent patient selection combined with peri-operative treatment of the condition.