Expert Commentary: Stuart Sondheimer, M.D. - 11/30/2009

Posted by Admin on November 30, 2009
Dry eyes affect many people, whether or not they have had Lasik. It is more common as we age and is more frequent in people who have rheumatologic diseases, such as rheumatoid arthritis,  and in people who have had chemotherapy for cancer. In dry eyes, the glands that make tears no longer make enough lubrication to make the eyes comfortable. Some patients can no longer wear contact lenses; others find that their eyes feel dry, scratchy, and irritated.

Lasik will generally make dry eyes worse. In lasik, a flap in the cornea is created with either a laser or an instrument called a microkeratome. Underneath this flap, corneal tissue is removed to reshape the cornea to better focus vision. Most patients who have had lasik will have an increase in the dryness of their eyes. This effect is most pronounced in the first months following surgery and tends to improve with time. Patients who are likely to have significant dry eyes after surgery are detected pre-operatively and encouraged to have PRK surgery instead of Lasik. In PRK surgery, the soft outer covering (epithelium) of the cornea is removed and an excimer laser is used to remove corneal tissue to reshape the cornea to better focus vision. This treatment usually does not make dry eyes worse and usually provides excellent vision without glasses or contact lenses.

Dry eyes can usually be helped with artificial tears. These tears are dropped in the eyes, several times a day as needed. Some patients benefit from having one or more of the ducts that drain their tears into the nose blocked with a plastic stopper. It takes seconds to have the stopper placed and is usually painless. Sometimes, an eyedrop called Restasis that stimulates tear production is useful to make dry eyes more comfortable. Rarely, other medication, such as corticosteroids may be prescribed to improve dry eyes.

With careful pre-operative screening, meticulous surgery, and excellent post-operative care, dry eyes are usually not a significant problem for people having Lasik.

Stuart P. Sondheimer, M.D.

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