Post-LASIK dry eye disease: A comprehensive review of management and current treatment options

Frontiers in Medicine · 13 authors, 11 centres

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TL;DR

This comprehensive review examines post-LASIK dry eye disease (Li-DED), the most common complication after LASIK, affecting up to 87.5% of patients. The paper details risk factors, including preexisting DED, female sex, older age, and surgical parameters, and evaluates treatment options such as cyclosporine A, diquafosol, artificial tears, autologous serum, growth factors, punctal plugs, omega-3 fatty acids, and thermal pulsation. The clinical significance lies in emphasizing preoperative assessment and early, individualized treatment to improve patient comfort and surgical outcomes.

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**Background:** Laser-assisted in situ keratomileusis (LASIK) is a common refractive surgery that reshapes the cornea by creating a flap and using an excimer laser. Dry eye disease (DED) is the most frequent complication after LASIK, affecting up to 87.5% of the global population, with a younger trend and higher prevalence in women. DED is a multifactorial disorder of the tear film and ocular surface, causing discomfort, visual disturbance, and inflammation. The paper reviews management and treatment options for post-LASIK DED (Li-DED).

**Methods:** This is a narrative review of published studies on Li-DED, covering pathophysiology, risk factors, surgical techniques (LASIK vs. PRK vs. SMILE), flap/hinge characteristics, and treatment approaches. The review synthesizes data from clinical studies, meta-analyses, and case series, focusing on management strategies.

**Key Results:** The incidence of Li-DED ranges from 20% to over 50% after LASIK, with lower risk after SMILE. Key risk factors include preexisting DED, female sex (especially premenopausal), older age, Asian origin, collagen vascular diseases, diabetes, and surgical parameters (e.g., ablation depth, flap thickness, suction time). Flap/hinge characteristics influence corneal sensitivity (CS) and DED: nasal hinge flaps show better CS recovery than superior hinges in some studies, while others find no difference. Thinner flaps (100 μm vs. 130 μm) may reduce DED severity. Treatment options include: (1) Cyclosporine A (0.05% emulsion) – enhances goblet cell density and tear production, FDA-approved for DED; (2) Diquafosol (3% solution) – activates P2Y2 receptors to promote mucin and fluid secretion; (3) Artificial tears – traditional therapy with emollients and demulcents; (4) Autologous serum – contains growth factors and bioactive proteins, effective for moderate-to-severe DED; (5) Growth factors (e.g., NGF) – improve corneal sensitivity and epithelial healing; (6) Punctal plugs – reduce tear drainage, safe for temporary use; (7) Omega-3 fatty acids – anti-inflammatory and promote nerve regeneration; (8) Eyelid-warming devices and thermal pulsation (Lipiflow) – treat meibomian gland dysfunction; (9) Intense pulsed light (IPL) – reduces evaporative DED; (10) Acupuncture – may increase lacrimal secretion; (11) PROSE scleral lenses – for severe cases; (12) Pregabalin/gabapentin – limited efficacy for Li-DED. Preoperative assessment using Schirmer test, TBUT, OSDI questionnaire, and corneal staining is critical; patients with severe DED should not undergo LASIK.

**Clinical Implications:** Li-DED is common but often temporary; however, some patients develop chronic symptoms. Preoperative identification and treatment of DED are essential to reduce complications. Postoperatively, preservative-free artificial tears are recommended for most patients, with more invasive options (e.g., punctal plugs, autologous serum) for severe cases. The choice of surgical technique (e.g., SMILE over LASIK) may reduce DED risk. Early and individualized treatment improves visual outcomes and patient satisfaction.

STUDY TYPE

narrative_review

SPECIALTY

ophthalmology

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ORIGINAL PAPER

PMC10126282

Post-LASIK dry eye disease: A comprehensive review of management and current treatment options

Frontiers in Medicine

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ABSTRACT

Laser-assisted in situ keratomileusis (LASIK) is a unique corneal stromal laser ablation method that uses an excimer laser to reach beneath corneal dome-shaped tissues. In contrast, surface ablation methods, such as photorefractive keratectomy, include removing epithelium and cutting off the Bowman’s layer and the stromal tissue of the anterior corneal surface. Dry eye disease (DED) is the most common complication after LASIK. DED is a typical multi-factor disorder of the tear function and ocular surface that occurs when the eyes fail to produce efficient or adequate volumes of tears to moisturize the eyes. DED influences quality of life and visual perception, as symptoms often interfere with daily activities such as reading, writing, or using video display monitors. Generally, DED brings about discomfort, symptoms of visual disturbance, focal or global tear film instability with possible harm to the ocular surface, the increased osmolarity of the tear film, and subacute inflammation of the ocular surface. Almost all patients develop a degree of dryness in the postoperative period. Detection of preoperative DED and committed examination and treatment in the preoperative period, and continuing treatments postoperatively lead to rapid healing, fewer complications, and improved visual outcomes. To improve patient comfort and surgical outcomes, early treatment is required. Therefore, in this study, we aim to comprehensively review studies on the management and current treatment options for post-LASIK DED.

CITATION EXPORT

Atena Tamimi, Farzad Sheikhzadeh, Sajjad Ghane Ezabadi et al.. Post-LASIK dry eye disease: A comprehensive review of management and current treatment options. Frontiers in Medicine. (2023). https://doi.org/10.3389/fmed.2023.1057685

AUTHORS

13 · 11 CENTRES

Atena Tamimi, Farzad Sheikhzadeh, Sajjad Ghane Ezabadi, Muhammad Islampanah, Peyman Parhiz, Amirhossein Fathabadi, Mohadeseh Poudineh, Zahra Khanjani, Hossein Pourmontaseri, Shirin Orandi, Reyhaneh Mehrabani, Mohammad Rahmanian, Niloofar Deravi

1Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2School of Medicine, Iran University of Medical Sciences, Tehran, Iran
3Students’ Scientific Research Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
4Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
5Student Research Committee, Zahedan Medical Sciences Branch, Islamic Azad University, Zahedan, Iran
6Student Research Committee, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
7School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
8Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran
9Bitab Knowledge Enterprise, Fasa University of Medical Sciences, Fasa, Iran
10Department of Clinical Biochemistry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
11Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran