The Facts About Dry Eye and Eye Surgery
Any surgery performed in or around the eyes has the potential to cause dry eye. Some forms of refractive vision correction surgery can affect the nerves that monitor eye moisture and send signals to the glands that produce tears. This can lead to not having enough tears to keep the eye lubricated.
Other surgeries can lead to dry eye if the glands themselves are affected by the procedure. If the lacrimal or meibomian glands in the eyelid are damaged, they may no longer produce enough tears or they may release tears that do not have the right chemical balance of oils, proteins, and water needed to keep the eye moist and healthy.
And some surgeries and cosmetic procedures can affect the muscles that control blinking. If people blink too slowly, or the eyes don’t close all the way when blinking, the tear film will evaporate, causing gritty dry eyes and blurry vision. Because dry eye is a chronic condition, it is important to see an eye care specialist for treatment.
During LASIK surgery, a flap is cut in the cornea so the laser can reshape the cornea to improve vision. Sometimes this can cause nerve damage, which makes it harder for the eye to properly gauge moisture levels. As a result, the eye produces fewer tears than it actually needs. About 60 percent of LASIK patients experience dry eye a month after surgery according to studies from the early 2000s.
For LASIK surgery to be successful, the eye’s surface must be as healthy as possible. This means having the right quality and quantity of tears. Surgeons now screen patients for dry eye before LASIK surgery by measuring the evaporation rate of tears in the eye. If dry eye is present, doctors will treat the condition using prescription eye drops or punctual plugs before surgery.
Post-LASIK dry eye usually improves in the months following surgery. New research, however, suggests that 28 percent of people actually develop dry eye symptoms three months after LASIK surgery. And many of those people do not report their symptoms to their doctors. Untreated dry eye can lead to corneal damage and vision loss, so talk to your doctor about any dry eye symptoms you may experience.
While people with severe dry eye are not good candidates for LASIK, there is another kind of refractive eye surgery called PRK (photorefractive keratectomy) that may be an option. In PRK, surgeons scrap the surface of the eye, rather than cut into the cornea. It takes longer to recover from PRK, but some experts believe this technique reduces the risk of dry eye.
Dry eye is common among people with cataracts and the surgery to remove them can worsen dry eye symptoms. More than 80 percent of people who have had cataract surgery experience occasional dry eye. This is because the surgery can damage the eye surface. Research also shows that it can make the meibomian glands — the structures in the lids that secrete the oils in tears —function less effectively.
Surgeons now screen patients for dry eye before surgery and treat even mild cases of the condition using prescription eye drops called cyclosporine (Restasis) or punctal plugs. This ensures a healthy eye surface, which, in turn, improves the vision after cataract removal and makes it easier for the eye to heal.
A retrospective review found that 26 percent people who undergo an eyelid lift — or blepharoplasty — experience dry eye after the surgery. The surgery can affect the glands in the eyelid that produce tears. This is usually temporary, but it can be permanent for some people. Research shows that some people with a history of dry eye actually experience a worsening of symptoms after an eyelid lift.
Botulinum toxin injections (Botox, Dysport, Xeomin, Myobloc) are currently the most popular cosmetic procedures. But they can lead to dry eye if the neurotoxin used to smooth crow’s feet is injected into the muscle that controls blinking. Over-the-counter eye drops can soothe and moisten the eye until the toxin wears off, but researchers suspect the condition could become permanent with repeated injections.
After some surgeries, such as refractive eye surgery, people may experience dry eye that resolves as the eye heals. In some cases, however, dry eye after surgery can become a chronic condition that, if left untreated, can permanently damage the eye surface and affect vision. Talk to your eye care specialist if dry eye symptoms persist after home treatment or grow worse over time.