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Having dry eye before LASIK surgery is a risk factor for severe dry eye after surgery

The JAMA Network Journals

CHICAGO - Having dry eye symptoms is a risk factor for developing more severe dry eye after undergoing laser-assisted in situ keratomileusis (LASIK) surgery, according to an article in the August issue of The Archives of Ophthalmology, one of the JAMA/Archives journals.

According to background information given in the article, LASIK surgery is effective in correcting refractive errors in the eye that require glasses or contact lenses to correct. Some people decide to have LASIK surgery because their dry eye symptoms make it difficult for them to comfortably wear contact lenses.

Post-LASIK dry eye lasts for at least one month after surgery. "Tear function and dry eye symptoms improve within several postoperative months in most cases; however, some patients still have dry eye 1 year after undergoing LASIK," write the authors. "Although the mechanisms for post-LASIK dry eye are unclear, more severe post-LASIK dry eye may develop in patients with preoperative dry eye for longer periods compared with subjects without preoperative dry eye."

Ikuko Toda, M.D., of the Minamiaoyama Eye Clinic, Tokyo, Japan, and colleagues studied the effects of LASIK surgery on patients with varying degrees of dry eye. The researchers categorized 543 eyes in 290 patients who had LASIK surgery into three groups: eyes with definite dry eye (DE group; 111 patients and 168 eyes), with probable dry eye (PDE group; 153 patients and 300 eyes) and without dry eye (NDE group; 49 patients and 75 eyes). After surgery, tests for dry eye were given at 1, 3, 6 and 12 months.

Dryness was more severe in the DE and PDE group than the NDE group at 6 months and 1 year after surgery. Tear function and ocular surface condition were more compromised after LASIK in the DE group compared with the NDE group. Dryness was a complaint among all groups, but differences in dryness among all groups were not significant at one month after surgery because those in the NDE group experienced some temporary post-surgical dryness that returned to normal at follow up. Dry eye complaints and compromised tear function were common among the DE group and persisted throughout follow up.

The authors conclude: "With the proper ocular surface management, patients with dry eye can be good candidates for LASIK. However, our results also suggest that preexisting dry eye is a risk factor for severe postoperative dry eye with lower tear functon, more vital staining of the ocular surface, and more severe dry eye symptoms until 1 year after LASIK. Patients with dry eye who expect complete resolution of their symptoms after LASIK with removal of contact lenses should be warned that their dry eye symptoms may persist after LASIK."

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(Arch Ophthalmol. 2002;120:1024-1028. Available post embargo at archophthalmol.com)

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