Post-LASIK Eye Issues: Managing Dry Eyes and Vision Changes

Post-LASIK surgery eye issues?

Hello,
I underwent LASIK surgery over three years ago to treat approximately 700 degrees of myopia in both eyes.
Less than a year after the surgery, my myopia increased by nearly 100 degrees, and it has remained that way until now.
After the surgery, I noticed that my eyes became very dry.
Before the surgery, the doctor conducted an examination and diagnosed me with mild dry eye syndrome, but stated that it would not hinder the surgery, so I agreed to proceed.
However, my dry eye condition worsened post-operatively, and even the artificial tears and eye drops prescribed by the doctor have not been effective.
Additionally, I frequently experience blurred vision, which was not an issue prior to the surgery.
I have consulted two or three doctors, and they all agree that I have dry eye syndrome and advised me to maintain a regular schedule and reduce eye strain.
However, in modern work environments, it is nearly impossible to limit screen time.
One doctor mentioned that I have excessive oil secretion blocking my tear glands, which contributes to the dryness.
He suggested that if it becomes severe, surgical treatment may be necessary, but he did not recommend any surgery, leaving me unsure of what to do next.

Furthermore, I have noticed that the sclera of my eyes sometimes appears bluish, but this is only in the parts that are exposed; the areas within the eyelids do not show this discoloration.
I am unsure of the cause.
Previously, when I used steroid eye drops, I experienced similar symptoms, but I have not used them recently, and the issue persists.

I would greatly appreciate it if you could take the time to respond.
Thank you!

Annika, 30~39 year old female. Ask Date: 2004/11/17

Dr. Cai Yuyuan reply Ophthalmology

1.
During LASIK surgery, a corneal flap is created, which can cause temporary damage to the corneal nerves.
As a result, patients may experience reduced tear production for three to four months post-surgery.
However, most patients gradually recover, and your situation may indicate inadequate recovery of tear production, leading to severe dry eye syndrome.
The initial treatment for dry eye syndrome is artificial tears, but most patients show significant improvement with appropriate medication.
2.
Excessive oil secretion can be managed by performing warm compresses around the eyes (using a warm towel for five to ten minutes), which may provide relief.
3.
The blue appearance of the sclera is likely due to the thinning of the sclera associated with high myopia and generally does not pose significant concerns.

Reply Date: 2004/11/17

More Info

Post-LASIK eye issues, particularly dry eyes and vision changes, can be quite distressing for patients. Your experience of worsening dry eyes and the development of myopia after LASIK surgery is not uncommon, and it raises several important considerations regarding the management of these symptoms.

Firstly, it’s essential to understand that LASIK surgery involves creating a flap in the cornea, which can temporarily disrupt the corneal nerves responsible for tear production. This disruption can lead to a decrease in tear secretion, resulting in dry eye symptoms. In your case, since you had pre-existing mild dry eye syndrome, the surgery may have exacerbated this condition. It’s not unusual for patients with a history of dry eyes to experience worsening symptoms post-operatively.

The management of dry eyes post-LASIK typically starts with the use of artificial tears. However, as you mentioned, if these are not providing relief, there are additional treatment options to consider. Here are some strategies that may help:
1. Punctal Plugs: These are small devices inserted into the tear ducts to block drainage, thereby increasing the moisture on the surface of the eye. This can be particularly beneficial for patients with moderate to severe dry eye symptoms.

2. Prescription Medications: If over-the-counter artificial tears are insufficient, your doctor may prescribe medications such as cyclosporine A (Restasis) or lifitegrast (Xiidra), which help to increase tear production and reduce inflammation.

3. Warm Compresses and Eyelid Hygiene: If your doctor suspects that oil gland dysfunction is contributing to your dry eyes, regular warm compresses can help to unclog blocked glands. Additionally, maintaining eyelid hygiene can improve overall eye health.

4. Environmental Modifications: Since you mentioned that your work involves prolonged computer use, consider implementing the 20-20-20 rule: every 20 minutes, take a 20-second break and look at something 20 feet away. This can help reduce eye strain and improve comfort.

5. Humidifiers and Air Quality: Using a humidifier in your workspace can help maintain moisture in the air, which may alleviate some of your dry eye symptoms.

Regarding the blue appearance of the sclera (the white part of your eye), this can sometimes be attributed to thinning of the sclera, especially in individuals with high myopia. The underlying structures, such as the choroid, can become more visible through the thinner scleral tissue, giving it a bluish tint. This is generally not a cause for concern, but it’s advisable to discuss this with your eye care provider to rule out any other potential issues.

Lastly, it’s crucial to maintain open communication with your ophthalmologist. If your symptoms persist or worsen, consider seeking a second opinion or consulting a specialist in dry eye disease. They may provide further insights or alternative treatment options tailored to your specific needs.

In summary, managing post-LASIK dry eyes and vision changes involves a multifaceted approach that includes artificial tears, potential prescription medications, punctal plugs, and lifestyle modifications. Your symptoms are valid, and with the right strategies, you can work towards improving your comfort and visual clarity.

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