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Does LASIK help dry eyes?

By Joel Hunter, MD | 7/12/17 8:03 AM
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Even as a big fan of LASIK, I’m not daring enough to tell you that LASIK is listed as a treatment for dry eyes. It’d be irresponsible to say LASIK cures dry eyes. It doesn’t. Now, if you’re waiting for the counterpoint, then hooray! You guessed right! Most of the rest of what we’re going to be talking about here are the reasons dry eyes can be helped or hurt when doing LASIK. The crux of the entire issue is the reason your eyes are dry. There is more than one cause and therefore there is more than one answer to this question. First we’ll tackle when LASIK can help dryness, then follow with when LASIK can add to the problem.

There are two reasons someone with contacts can have dry eyes. (I’m picking on contacts because about 95% of the people I talk to about dryness are contact lens wearers.) The first is that your eyes are dry and therefore intolerant of contact lenses. The second is that your eyes are intolerant of contact lenses and therefore dry. While it can look like the rearranged words in those sentences are just semantics, there’s a big difference between the two. There are folks with eyes that have underlying pathology leading to dryness and the burning, irritation, and “foreign body” sensation. As you’d imagine, a contact lens sitting on an eye like that is going to just make things worse. When this is the case, you’ve got a diagnosis of dry eyes and contact lens intolerance is the result. LASIK should be approached with extreme caution in these situations, and is usually recommended against.

In the other camp, there are people who dislike their contacts because they make their eyes feel irritated. And it’s especially bothersome because their eyes feel fine without the contacts. These cases—and in my experience it’s the majority of them—are a result of contact lens intolerance causing dry eyes. There are many reasons your eyes may not like contacts, and those reasons are more common than a general medical diagnosis of baseline dry eyes. Here’s the question I would ask to determine if this is you: “Do you need to use artificial tears when you aren’t wearing contacts?” If the answer is, “Yes, I have a bottle of tears in my pocket right now,” then you probably have a diagnosis of dry eyes. If the answer is “hardly ever,” then there’s a very high chance you don’t have a diagnosis of dry eyes.

As someone who was in the first group—those who have eyes that feel fine except when wearing contacts—I can attest firsthand that not needing contacts fixed my problem. I struggled with dry eyes for years. This is revolting, but I’d sometimes try to make myself gag so my eyes would water to make them see and feel better. Less revolting, I’d try to yawn to do the same thing. I looked like either I was going to be sick, or like I was very sleepy, for an unacceptable amount of the time. The decision to get LASIK in med school was largely driven by the fact I couldn’t wear contacts in surgery without them drying my eyes out. Then I got LASIK, and my problem ceased immediately and permanently. Now I see patients every week with the same issue I had with contacts and dry eyes, and I get to watch them be cured of it when they don’t need contacts anymore.

There’s another side to the story, however. There’s no question about whether dry eyes exists as a diagnosis completely aside from contact lens use. The causes of a diagnosis of dry eyes are surprisingly diverse. Some of them are curable, some are treatable, and some have no great solution. Knowing the difference between which causes of dry eyes are fixable and which ones aren’t is one of the boring, behind-the-scenes characteristics of a good LASIK surgeon vs. a LASIK surgeon with a lot of sad, angry patients. Here’s my advice if you’re someone who suffers from burning and irritated eyes even when you don’t wear contacts: find a LASIK surgeon who is knowledgable about causes and treatments. Even more important, however, you want them to be a cautious, timid, even wimpy person when it comes to the decision about whether LASIK is a possibility. The question should never be “could we do LASIK?” and should always remain “should we do LASIK?”

LASIK can make life much better or much worse if you suffer from dry eyes. As the great Dan Durrie told me many times, “LASIK is 95% knowing what to do, and 5% doing it.” Knowing why you have dry eyes, and how to fix the cause is part of that 95%. It may be LASIK is best avoided. Or if you’re lucky, it may be the reason you’re saved from being the weird guy who sometimes gags or yawns randomly.

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These articles are brought to you by Hunter Vision. We help people in Orlando discover life after glasses and contacts.
 
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