LASIK-associated Dry Eye and Neurotrophic Epitheliopathy: Pathophysiology and Strategies for Prevention and Treatment

Purpose: To review the pathophysiology of LASIK-associated dry eye conditions and provide insights into prophylaxis to decrease the incidence of dry eye after LASIK and to treat the condition when it occurs. Methods: A review of the literature was performed on LASIK-associated dry eye and the experience of the authors was summarized. Results: LASIK has a neurotrophic effect on the cornea, along with other changes in corneal shape, that affect tear dynamics causing ocular surface desiccation. Dry eye is one of the most common complications of LASIK surgery. Symptoms of dryness may occur in more than 50% of patients, with other complications such as fluctuating vision, decreased best spectacle-corrected visiual acuity, and severe discomfort occurring in approximately 10% of patients. Preoperative dry eye condition is a major risk factor for more severe dry eye after surgery and should be identified prior to surgery. Optimization with artificial tears, nutrition supplementation, punctal occlusion, and topical cyclosporine A in patients with symptoms or signs of dry eye prior to LASIK decreases the incidence of more bothersome symptoms following surgery. Patients with LASIK-induced neurotrophic epitheliopathy often respond to topical cyclosporine A treatment, which treats the underlying inflammation and may benefit nerve regeneration. Conclusions: LASIK-induced dry eye and neurotrophic epitheliopathy are common complications of LASIK surgery. Optimization of the ocular surface prior to surgery decreases the incidence and severity of postoperative symptoms of the condition. [ J Refract Surg . 2008;24:396–407.]