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Which Is Better for Patients With Dry Eye: LASIK or SMILE?

Posted on February 16, 2020

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.

woman with dry eyes

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.

patient receiving cataract surgery

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:

  • Gritty
  • Blurred
  • Swollen
  • Painful
  • Irritated

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.  

References

Lenticule May Beat LASIK in the Dry Eye Arena. (February 2012). EyeWorld.

Dry Eye After Small Incision Lenticule Extraction (SMILE) Versus Femtosecond Laser-Assisted in Situ Keratomileusis (FS-LASIK) for Myopia: A Meta-Analysis. (November 2016). PLoS One.

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.

How to Completely Get Rid of a Black Eye (Fast)

Posted on August 29, 2019

woman wearing eyepatch

 

A black eye can surround your whole eye, or it can just affect the area below your eye. It occurs as a result of blood collecting in the area. (Learn More)

A black eye itself is usually not serious, but it is possible that accompanying injuries could be problematic. If symptoms like persistent headache or vomiting occur, it is important to get medical attention promptly. (Learn More)

Treatment for a black eye usually involves ice, over-the-counter pain relievers, and elevating your head. If you care for a black eye properly, you can promote the healing process, but there isn’t a quick fix to make it immediately go away. The bruising has to subside on its own.

Tell your doctor about any treatments you are using to ensure their safety. (Learn More)

black eye upclose

What Is a Black Eye?

A black eye describes bruising in the eye area. Blood collects in the tissues, causing a purple, blue, or black appearance of the area around your eye. There is usually not an injury affecting your actual eye, just the area that surrounds it.

In addition to the darkened skin, you may also experience:

  • Pain in the area.
  • Blurry vision.
  • Swelling in the affected area.

Some symptoms can indicate that a black eye may be accompanied by a potentially serious head injury. These symptoms include:

  • Double vision.
  • Blood on the eye’s surface.
  • Loss of consciousness or fainting.
  • Loss of vision.
  • Not being able to move your eye.
  • Ongoing or severe headache.
  • Fluid or blood coming from your nose or ears.

Any of these symptoms warrants a trip to the emergency room. A serious head injury can result in brain damage or death.

How Serious Can a Black Eye Be?

Most black eyes will heal in a few days without medical intervention. They usually occur when something hits your nose or eye. It is possible for both eyes to be blackened at the same time, depending on your injury.

Any trauma to the face may cause serious injuries, such as a skull fracture or bleeding in the brain.

Other potentially serious injuries that may accompany a black eye include:

  • Hyphema. This issue is characterized by bleeding in your eye. Hyphema may negatively affect your vision and cornea.
  • Ocular hypertension. This may occur along with eye or facial trauma. It is characterized by increased pressure inside your eye. Eyesight damage is possible if this is left untreated.

Black Eye Treatments

ice bag

When you experience a black eye, it is best to be evaluated by a doctor. They can determine the extent of your injury and determine if something more serious is present, such as facial trauma or hyphema.

When a black eye is minor, home treatment is usually sufficient. Icing the eye can reduce swelling, lessen pain, and help to alleviate bruising.

When you apply ice to your eye, use a washcloth or similar barrier between the ice and your skin to prevent a cold injury.

Never ice the affected eye for more than 20 minutes at a time. Leaving the ice on for longer puts you at risk for frostbite in the area.

The cold helps because it constricts the blood vessels in the area. You can apply ice several times per day, as long as you use the proper technique.

Doctors may recommend over-the-counter pain medicine to alleviate any discomfort you experience. It is best to stick with acetaminophen. Both aspirin and nonsteroidal anti-inflammatory drugs may thin your blood and worsen the appearance of your black eye.

There are other methods that may help to reduce the appearance of a black eye.

  • After about two days of icing the affected eye, you can start applying warm compresses to the area. This helps to promote healing by increasing blood flow.
    Be careful to avoid hot compresses that could burn your skin. As with cold compresses or ice, you can apply the heat for up to 20 minutes at a time.
  • Massage the area surrounding the blackened area. Do not massage the bruise.
    You can start this about 24 hours after you experience the black eye. This may speed up the healing process by activating the lymphatic system in the area.
  • When you are sleeping, keep your head elevated above the rest of your body. This encourages drainage, which may help to reduce the amount of discoloration and swelling you are experiencing.

Black Eye Prevention

Since most people experience a black eye as the result of trauma, reduce your risk of experiencing a trauma. Wearing a seatbelt is important since facial injuries are common during motor vehicle accidents.

There are other ways to reduce your risk of falls.

  • When you are doing any activity where facial trauma is possible, always wear protective eye gear, such as goggles. These will reduce the risk of taking a direct blow to the eye. They also help to decrease the risk of foreign objects getting into your eye.
  • Evaluate your home for hazards that could cause you to trip and fall, such as clutter on your floors, loose carpeting and rugs, and similar hazards.
  • Use assistive devices if you are a fall risk.

If you experience a black eye, get a doctor’s evaluation. They can determine the extent of the injury and recommend treatment options. It’s important to rule out brain injury.

While the above treatment methods won’t get rid of the black eye immediately, they will promote the healing process and could potentially shorten the overall healing timeline.

References

Black Eye Symptoms. (May 2019). American Academy of Ophthalmology.

Ocular Hypertension. American Optometric Association.

What Is a Black Eye? (May 2019). American Academy of Ophthalmology.

How to Properly Ice an Injury. (July 2019). Verywell Health.

What Is a Black Eye and What Can I Do About It? (September 2018). Medical News Today.

It’s (Eye) Allergy Season!

Posted on April 4, 2018

Caution Sign - Allergy Season Ahead

By: Dr. Paul CaseyNevada Eye Care, an NVISION Company

The cold winter months have passed and spring is here upon us. As we look forward to the warm weather and outdoor events, there is just one thing that a great number of us are dreading…allergies.

You know the drill: itchy, red, or even burning sensations in your eyes. If this sounds like you, you’re not alone. The American College of Allergy, Asthma, and Immunology estimates that 50 million people in the United States have seasonal allergies. This affects approximately 30% of adults and 40% of children.

Common causes of allergies are airborne around you every day both indoors and outdoors. Things like pollen (grass, trees, weeds), mold, dust, and pet dander triggers the cells in your eyes release histamine and other chemicals that cause inflammation.

Luckily, there’s relief and tips for prevention to avoid or limit exposure with your trigger(s).

  • Outdoors
    • Avoid going outside and close windows when pollen count is high
      • How do I know what the pollen count is you may ask? Click here to see what Google’s forecast is.
    • Use A/C and air filters/purifiers and be sure to swap them out as recommended by the manufacturer
    • Wear sunglasses or glasses when outside to keep the pollen out of your eyes
  • Indoors
    • Dust mites
      • Use special pillow covers to keep allergens out
      • Wash bedding frequently in hot water
      • Consider replacing old mattresses
      • Clean floors with a damp mop
      • Replace carpeting with hardwood for an easier clean
    • Mold:
      • Keep humidity levels in homes below 30-50%
      • Consider having an expert in if any water damage has occured
    • Pets:
      • Keep animals outside as much as possible and out of the bedroom
      • Wash your hands after touching pets
      • After being near a pet, wash your clothes

For any contact lens wearers, you may want to remove your contacts and opt for your eyeglasses until your allergy symptoms are gone. This is because the surface of contact lenses can attract and accumulate airborne allergens. If wearing your glasses is not an option, you can switch to daily disposable contacts to avoid allergen and other debris buildup.

Experiencing allergies now? Some treatments for allergies include:

  • Artificial tears
  • Decongestant eye drops (do not use long-term!)
  • Oral antihistamines
  • Allergy shot
  • Prescription medications

A last bit of advice: Avoid rubbing your eyes, it will only irritate your eyes more!

How Do I Know If I Have Dry Eye and What Are My Options?

Posted on March 26, 2018

By: Dr. Paul Casey, Nevada Eye Care, an NVISION Company

Dry Eye, one of the most common eye conditions treated by physicians, is an irritating and sometimes painful condition in which the eye fails to properly produce enough or quality tears that lubricates the eyes. If left untreated, it can lead to ulcers, scars on the cornea, and even impairment of vision.

People who are at risk or suffer from dry eye often include those who:

  • Wear contact lenses, especially for prolonged periods of time
  • Are taking medications such as antihistamines or birth control pills
  • Are over 50, especially women going through menopause
  • Have specific diseases such as Sjogren’s Syndrome, rheumatoid arthritis and collagen vascular disease
  • Have eyelids that don’t close properly due to structural abnormalities
  • Live in dry climates (like here in Las Vegas!)

Dry eye syndrome is particularly prevalent in desert climates like ours here in Las Vegas, Nevada. Other signs and symptoms which usually affect both eyes may include:

  • Pain
  • Sensitivity to light
  • A feeling of a foreign body or sand in the eye (gritty)
  • Itching
  • Stinging
  • Irritation
  • Redness
  • Blurring of vision
  • Eye fatigue after short periods of reading
  • Periods of excessive tearing

If you suffer from dry eye, there’s good news- relief is possible! NVISION® provides a variety of treatment options to relieve dry eye and the best course of action is to book a dry eye evaluation at a center near you. If you’re near the Las Vegas area, I hope to see you!

Typically, the first line of treatment for dry eye syndrome is usually lubrication with artificial tears. If artificial tears are applied more than four times per day, greater treatment may be necessary.

For more advanced dryness, prescription anti-inflammatory therapy can actually increase tear production. Prescription dry eye treatment has been shown to improve the symptoms of dry eye, as well as reduce the ongoing microscopic damage from this condition.

Eye doctors also often recommend closure of the tear drainage system to increase the volume of the tear film. Closure is accomplished with a small plug, which fits comfortably into the tear drainage system. Placement of these punctal plugs is a quick and painless office procedure.

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