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Naturally occurring dry eye and dry eye related to Lasik can cause discomfort, vision fluctuations, slow healing,
exacerbate astigmatism, damage epithelium, and cause poor vision quality. Fortunately,
there are many techniques to resolve dry eye problems. This article
discusses naturally occurring dry eye, Lasik induced dry eye, and dry eye treatment solutions.
Lasik Dry Eye
The amount that dry eye symptoms affect an individual depends
on many factors. For the vast majority of conventional or
custom wavefront Lasik, Bladeless Lasik, PRK, LASEK, or Epi-Lasik refractive surgery recipients, the degree of dry eye
symptoms is not significant enough to cause difficulties.
Even those who do have some trouble most often find the dry eye
symptoms resolve within the normal six-month healing period.
PRK Dry Eye
PRK and its cousins LASEK and Epi-Lasik may induce dry eye symptoms,
however Lasik and Bladeless Lasik seem to be more commonly associated
with problematic dry eye symptoms. Although what is discussed here
relates to all refractive surgery procedures that induced dry eye
problems, Lasik is referenced.
Exactly why Lasik induces dry eye is not totally understood.
There is no doubt that Lasik induced dry eye is caused by a multitude
of events. If the right combination of these events occurs, you
have dry eye symptoms. It is generally thought that Lasik induced
dry eye is caused by the nerves in the cornea being severed when
the Lasik flap is created, when the excimer laser removes corneal
tissue, and/or by the change in shape of the cornea.
The disruption of the cornea nerves causes a decrease in sensitivity
of the cornea and interrupts the flow of information to the entire
tearing system. The lack of sensitivity may cause a patient to blink
less. The disruption of the normal flow of information may cause
the system to not know that more tears are needed or that specific
components of the tears are needed. It is also possible that the
disruption of the corneal nerves will provide the sensation of dry
eyes, when in-fact the eyes are appropriately wet, or the sensation
of normal eyes, when in-fact the eyes are inappropriately dry.
Although the corneal nerve sensitivity returns in a relatively
short period of time, while they heal there can be dry eye symptoms.
Most Lasik induced dry eye is resolved within the normal six-month
healing period.
Different Causes of Dry Eye
To properly maintain or resolve refractive surgery induced dry
eye problems, it must first be determined exactly what is contributing
to the dry eye. It is not as simple as not making enough tears.
Dry eye symptoms are cause by one or more of three occurrences.
Reduced tear production. Increased tear drainage. Distressed quality
of tears. Each requires a very different response and responding
to the wrong cause can exacerbate the true cause of dry eye symptoms..
Tear Layers
There are actually three layers of tears. The outermost is the
lipid, center is the aqueous, and at the base of the tears is the
mucin. Each of these are produced in separate glands near the eye
and carried to the eye in tiny channels. These three combine to
provide the eye, particularly the cornea, with nutrients and lubrication.
The mucin makes the tear viscous and allows it to spread evenly
over the whole eye. If there isn't enough mucin, then the tear doesn't
smooth out and cover the cornea. The mucin acts like a "glue" and
helps hold the tears to the eye. The aqueous is the thickest layer
in the tear and is the water that protects and lubricates. The lipid
is the outermost layer and is essentially oil. The oil helps keep
the aqueous from evaporating too quickly.
The other important component to healthy tears are the drains
called punctum. These are tiny holes at the upper and lower edges
of your eyelids that allow tears to flow out while new tears are
developed and delivered to the eye. There one upper and one lower
punctum for each eye.
Dry Eye Relief
Below are some ideas for treatment to
manage dry eye problems, in no particular order. These techniques
have helped patients with Lasik induced dry eye while they healed
after surgery. These techniques can be used by anyone experiencing
dry eye symptoms, not just those who have Lasik induced dry eye
symptoms. All techniques should be verified with an eye doctor before
utilization.
Eye Health Examination
Your doctor should be evaluating the health of your eyes. Dry
eyes slow healing and can cause other problems. The doctor needs
to be sure some other health problem is not contributing to your
dry eyes.
Check Medications
Many medications have dry eye inducing properties. Antihistamines,
allergy medicine, hormone replacement therapy, other over-the-counter
and prescription medications can exacerbate dry eye symptoms. Tell
your doctor any and all medications you are taking, even if you
think they have nothing to do with your eyes. The darnedest things
can contribute to dry eyes. Check with your doctor if an alternative
that is less likely to affect dry eyes is available.
Dry Eye Testing
There are two primary tests to determine what is causing the
dry eye symptoms. The Shirmer test is to determine tear quantity.
This is the process of putting tiny strips of paper in your lower
eyelid and determining how far out the tears soak the paper in a
specific amount of time. The other is called a Tear Break-Up Test
(TBUT). TBUT is the application of a staining solution that shows
where on the cornea and when the tears break apart.
Drink Water
Drinking plenty of water and restorative fluids may seem obvious,
but if you are dehydrated, your eyes will be dehydrated too.
Avoid Dry Areas
Air conditioning, heating, extreme cold and extreme hot weather
will dehumidify the air. If possible, avoid these areas. Air movement
will also dry tears. Avoid having a fan directly on your face.
Humidify
Wherever possible add a humidifier. A humidifier in your home
or at your workplace can help dramatically. Add a humidifier to
your bedroom for nighttime and, if possible, around your work area.
If you don't have a humidifier, just bring a pot of water on the
stove to a slow boil. You can even add potpourri or soup bullion
to make the house smell nice.
Artificial Tears
Be sure any artificial tears you use are free of preservatives.
Preservatives can actually cause dryness. We have a list of artificial tear eye drops that includes if they have preservatives
and what type. You can always tell they are truly preservative free
because they cost quite a bit more than the preserved drops and
they come in single-use vials.
Each artificial tear manufacturer uses a slightly different formula
and one may be better for you than another. Try different
brands until you find one that is comfortable and provides relief.
Use these drops whenever you think you need them. If you do not
notice an improvement, make an eye drop schedule and stick to it.
Remember, your corneas may not be able to tell you they need more
tears. Start with four times a day and adjust accordingly. Generally,
you cannot use too many preservative-free artificial tears.
Make Your Own Artificial Tears
Several studies have shown that Autologous Platelet-rich Plasma
eye drops resolve difficult dry eye symptoms where common artificial
tears fail. The eye drops are manufactured by drawing the patient's
own blood, extracting the plasma, and concentrating the platelets
by centrifugation. Discuss this option with your eye doctor.
Flax Seed Oil
This is a nutritional supplement that you can purchase at most
health food and vitamin stores. Taking flax seed oil each day has
been reported to help with dry eye by increasing the quality and
quantity of lipid tear layer. The flax seed oil liquid seems to
get better results than the tablets, but it tastes awful. Mix it
with fruit juice or even yogurt - something with a strong flavor.
Dosage is around two tablespoons a day, or as recommend by the manufacturer.
Nutritional Supplements
Studies have found that certain combinations of vitamins, minerals,
and omega-3 fatty acids tend to decrease inflammation and improve
tear gland secretions. TheraTears Nutrition, HydroEye, and
Hydrate Essential are examples of these nutritional supplements.
Fish consumption, such as salmon, sardines, and mackerel, can be
helpful in adding omega-3 to diet.
Lubricating Gels
Along with the preservative-free eye drops, you can get gels
to use at night. A few brands are MoistureEyes, GenTel, and Refresh
PM. These are especially helpful for those who do not close their
eyes completely at night.
Punctal Plugs
An eye doctor can provide these tiny plugs that stop or slow
the flow of tears away from your eyes. See Lasik and punctal plugs
Protective Lenses
In general, protect your eyes from windy weather or extreme cold/hot.
If you are one of those who sleeps with eyes partly open, using
a lubricating gel and small swimming goggles may be appropriate.
Blepharitis Treatment
Scrubbing under the eye lids with warm water and baby shampoo,
plus warm compresses that are the normal treatments for blepharitis
often are helpful. The warmth makes the oil in the tears flow better
and the scrubs keep the openings open. Learn more at our Lasik and Blepharitis article.
Antibiotics
You need to talk to your doctor about this, but some antibiotics
may be helpful. A new application of this treatment is in the drug
Restasis.
Steroids
Some doctors try to treat dry eyes with topical steroids. While
this may be helpful, long-term use of steroids can result in other
problems. Consult your doctor.
Restasis
This is the brand name of a prescribed ophthalmic eye drop with
a small amount of cyclosporine included. Cyclosporine is an
anti-inflammatory. Restasis can help dry eye be reducing inflammation around the
tiny channels that carry the mucin, aqueous, and lipids to the eyes.
If swollen shut, these channels cannot deliver the lubricants necessary
for a health tear film. Although some relief may arrive as
quickly as within a week of use, Restasis achieves its full effect
after at least three months of continuous use. Restasis is
the only medication approved by the FDA for the treatment of chronic
dry eye (keratoconjunctivitis sicca).
Second Opinion
If you think your doctor is not knowledgeable enough to help
you with your problem, get a second opinion. At the very least,
you will know if you are receiving the care and treatment you should
be receiving.
Looking For Best Lasik Surgeon?
If you are ready to choose a doctor to be evaluated for conventional
or custom wavefront Lasik, Bladeless Lasik, PRK, or any refractive surgery procedure, we recommend you consider a doctor who has been evaluated and certified by the USAEyes nonprofit organization.
Locate a USAEyes Evaluated & Certified Lasik Doctor.
Personalized Answers
If this article did not fully answer your questions, use our
free Ask Lasik Expert patient forum.
