Tears do more than help you express sadness. This precious liquid whisks away irritants before they attack the eye's delicate surface. Each tear also contains substances crucial for healthy eye tissue.
When you're recovering from surgery, your eyes need more tears than ever. But some operations can enhance dry eye symptoms. And if you have severe dry eye, you might not be a candidate for the procedure you want.
How Does Surgery Cause Dry Eye?
LASIK and SMILE surgeries reshape your eye, so light and images focus on the retina in the back of your eye. The incisions necessary for that reshaping could interfere with your body's ability to produce tears.
During LASIK, your doctor:
- Numbs your eye.
- Uses a laser or scalpel to cut a small flap in the cornea.
- Folds up that bit of tissue.
- Uses a laser to reshape the tissue below.
- Unfolds the flap and settles it in place.
During SMILE, your doctor:
- Numbs your eye.
- Uses a laser to reshape layers of tissue within the cornea.
- Removes excess cells with suction.
SMILE surgery involves no flap. That means, experts say, that fewer nerves within your eye get cut. That's crucial, as those nerves both tell your eye when it's dry and trigger ducts to pump out fluids. If they're intact after surgery they could, in theory, produce fewer episodes of post-op dry eye.
Which Surgery Works Best?
Each eye is different, and a surgery that works best for your eyes might be terrible for your friend or neighbor. That said, doctors have dug into the data about LASIK and SMILE, and a winner is beginning to emerge.
Dry eye after both LASIK and SMILE is transient, researchers say. Anyone who has surgery will have eye discomfort, including cells that may feel:
These symptoms are usually mild, and they should fade quickly. But studies suggest they sometimes go away faster after SMILE. In one study, researchers found that LASIK came with more dry-eye complaints than SMILE at six months. But both groups had similar experiences at the 12-month mark.
In a second study, researchers found that 80 percent of SMILE patients didn't use artificial tears six months after surgery. Among LASIK patients, 57 percent didn't need these eye drops.
If you have dry eyes now, some surgeries could make your symptoms worse. Your doctor might recommend SMILE as your surgical choice to further reduce your risk of discomfort after the procedure is through.
But this surgery is only recommended for people with nearsightedness. If you have another form of vision loss, you'll need LASIK. That's true even if you have dry eye.
Treating Dry Eye Before Surgery
The healthier your eyes are before the surgery begins, the quicker your recovery will be. If your doctor identifies dry eye during your presurgical screening exam, there are plenty of treatment options you can try together.
Experts say doctors can treat dry eyes with:
- Prescription eye drops. These solutions encourage your glands to make more tears. Your doctor can also use drops to reduce eyelid or cornea swelling.
- Tear duct plugs. A tiny silicone stopper can keep your tears from leaving your eyes.
- Warm compresses. Blocked glands in your eyes keep tears from flowing. Heat combined with massage can open them again.
- Light therapy. Your doctor can use tiny pulses of light to open up blocked ducts yet more.
Doctors say pre-surgery dry eye treatment is crucial. That's true whether you need LASIK or SMILE. Your eyes will be healthier, and they will heal faster.
And the treatments work. In the past, people with serious dry eye problems couldn't get surgery. Now, with these treatment options, they can.
Your doctor must watch your progress carefully and advise you on surgery options. If you don't make enough progress, you may need to postpone or even halt your surgery plans.
Lenticule May Beat LASIK in the Dry Eye Arena. (February 2012). EyeWorld.
Dry Eye Disease Following Refractive Surgery: A 12-Month Follow-Up of SMILE Versus FS-LASIK in High Myopia. (2015). Journal of Ophthalmology.
SMILE May Induce Less Dry Eye Than LASIK. (June 2015). American Academy of Ophthalmology.
Point-Counterpoint: SMILE vs. LASIK. (February 2019). Review of Ophthalmology.
Dry Eyes. (March 2019). Mayo Clinic.