Discomfort After LASIK: Causes and Solutions for Eye Strain

Secondary refinement of myopic laser surgery?

Hello Dr.
Wang, my right eye underwent a second fine-tuning after LASIK surgery for myopia (the first surgery left a -1.00 diopter correction to accommodate future presbyopia without needing reading glasses).
However, due to poor adaptation one month post-surgery, I had a second fine-tuning procedure.
It has now been over two months since the second laser adjustment.
After this procedure, my right eye has started to feel sore daily, beginning from the brow and extending to the entire eye socket and eyeball (but there is no tearing, light sensitivity, or itching).
Sometimes, the soreness starts just 10 minutes after waking up.
I do not watch television and use the computer and phone for about 3 to 4 hours a day, taking breaks every 10 minutes or less for 2 to 3 minutes, and I consistently apply warm compresses, massage, and focus on distant objects (over six meters away).

I would like to ask the doctor if eyes that have undergone two laser fine-tuning procedures are more prone to dryness, and what the reasons might be.
Or could the soreness in my right eye simply be due to dry eye after the second laser adjustment? During my follow-up visit, the doctor only prescribed medication to relieve fatigue and mentioned that the healing process is normal.
I am unsure about the cause of this soreness and whether I need to undergo further examination.
Thank you.

Kevin, 40~49 year old female. Ask Date: 2016/03/01

Dr. Wang Zhishun reply Ophthalmology

Hello, dry eye syndrome is a possibility, but other corneal issues cannot be ruled out.
It may be advisable to consider a consultation with the cornea department at a medical center.

Reply Date: 2016/03/01

More Info

After undergoing LASIK surgery, it is not uncommon for patients to experience discomfort, including eye strain, especially after multiple procedures. Your situation, where you have undergone a second adjustment surgery and are now experiencing persistent discomfort in your right eye, raises several important considerations.

Causes of Discomfort After LASIK
1. Dry Eye Syndrome: One of the most common side effects of LASIK surgery is dry eye syndrome. The procedure can temporarily reduce tear production, leading to dryness and discomfort. Patients who have undergone multiple surgeries may be at a higher risk for this condition due to additional trauma to the corneal nerves, which play a crucial role in tear production. Symptoms of dry eyes include a gritty sensation, burning, and fatigue, which could explain the discomfort you are experiencing.

2. Corneal Healing: After LASIK, the cornea undergoes a healing process. If you have had a second procedure, the healing might take longer, and the cornea may be more sensitive. This sensitivity can lead to discomfort, especially when using screens for extended periods.
3. Visual Fatigue: Prolonged screen time, even with regular breaks, can lead to digital eye strain. Symptoms include discomfort, blurred vision, and headaches. The combination of LASIK recovery and screen use may exacerbate these symptoms.

4. Overcorrection or Undercorrection: If the second procedure did not achieve the desired refractive outcome, it could lead to visual discomfort. Overcorrection can result in hyperopia (farsightedness), while undercorrection can leave residual myopia (nearsightedness), both of which can cause strain as the eyes work harder to focus.

5. Muscle Strain: The muscles around the eyes may become fatigued from trying to compensate for any visual discrepancies or discomfort. This can lead to a sensation of tightness or strain in the brow and eye area.

Solutions and Recommendations
1. Artificial Tears: If dry eye is suspected, using preservative-free artificial tears can help alleviate symptoms. These can provide moisture and comfort to the eyes.

2. Follow-Up with Your Surgeon: It is essential to maintain regular follow-ups with your ophthalmologist. If your discomfort persists, a thorough examination may be necessary to rule out any complications or to assess the healing process of your cornea.

3. Adjust Screen Time: Implement the 20-20-20 rule: every 20 minutes, look at something 20 feet away for at least 20 seconds. This can help reduce eye strain.

4. Warm Compresses and Eye Massage: Continuing with warm compresses and gentle eye massages can promote better circulation and comfort in the eye area.

5. Consider Visual Therapy: If visual fatigue is a significant issue, discussing visual therapy with your eye care provider might be beneficial. This can help improve visual comfort and reduce strain.

6. Evaluate Prescription Needs: If you are experiencing visual discomfort, it may be worthwhile to have your prescription evaluated. Sometimes, additional corrective lenses for computer use can help reduce strain.

7. Monitor Symptoms: Keep a diary of your symptoms, noting when they occur and their severity. This information can be invaluable for your doctor in diagnosing the issue.

Conclusion
In summary, discomfort after LASIK, especially following multiple procedures, can stem from a variety of factors, including dry eye syndrome, corneal healing, visual fatigue, and muscle strain. It is crucial to communicate openly with your eye care provider about your symptoms and concerns. They can provide tailored advice and treatment options to help you manage your discomfort effectively. Remember, while some discomfort is common post-surgery, persistent or worsening symptoms warrant further investigation to ensure optimal recovery and visual health.

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