Lasik, Dry Eyes, and Blurry Vision

Discussion in 'Laser Eye Surgery' started by Mark, Mar 2, 2004.

  1. Mark

    Mark Guest

    I had Lasik almost four years ago and everything is nearly perfect,
    except for my dry eyes. I can't say that my eyes have ever been
    overly moist, but now they seem unusually dry. That's not the bad
    part. Every once in a while (about once or twice a month), I wake up
    with blurry vision in my left eye (sometimes my right, but almost
    always in my left). It seems my eyelid is sticking to my eyeball, and
    at some point during the night (sometimes right when I wake up) I
    shear off the topmost layer of cells off my eyeball (kind of like
    chipping paint off your car). This causes a mild stinging sensation
    and blurry vision that lasts almost 24 hours. I can prevent this from
    occurring by applying an eye ointment (Refresh P.M. by Allergan)
    before bed.

    When this first started occurring, I went to my eye doctor to be
    examined. He looked at the damaged area and confirmed that there
    appeared to be a patch roughly 0.05"x0.05" in size sheared off. He
    had never seen or heard of this before and he did not offer me much
    advice except for the eye ointment.

    As a mechanical engineer, I have my own opinion on the subject: The
    Lasik procedure involves cutting a thin layer (I'll call it the "Lasik
    Layer") from the front portion of the eyeball. This may have altered
    the strength of the cells that reside on the "Lasik Layer", or it may
    have altered the moisture layer that resides on the outside of the
    eyeball. These are only guesses, but the bottom line is that this
    problem started after Lasik.

    Has anyone heard of this condition? Is there anything that might
    help? I've heard of Restasis but I know nothing of it. Will this
    help relieve the dry eyes and maybe the morning stickiness?

    Thanks for the input.
    Mark, Mar 2, 2004
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  2. Mark

    Dr. Leukoma Guest

    (Mark) wrote in
    If you do a search in PubMed or Medline, you will come up with at least one
    study reporting an increased incidence of similar "eye events" following
    LASIK and PRIK. You will also run across studies reporting a link between
    the pre-operative prescription, i.e. the amount and depth of ablation, and
    dryness following LASIK.

    Using an ointment at night is standard protocol for recurrent erosion(RCE),
    which is the name for your condition. Restasis is not a treatment for RCE,
    but has been shown to help dry eye. It works by modulating the
    inflammatory response. Inflammatory cytokines have been implicated in dry
    eye, whatever the cause. You might look at the Theratears website. Their
    Theratears Nutrition attempts to treat the inflammatory response of dry eye
    with omega-3 EFA's (i.e. fish oil). Restasis is very expensive, and takes
    several months to have an effect, if it works at all in your case. As a
    side note, the vehicle for Restasis is an oil, and so may have some effect
    on helping to prevent the RCE via lubrication. However, that would not be
    considered a main effect, but a side effect.

    Reports of urgical treatments for anterior basement membrane dystrophy
    following LASIK using PTK/PRK can also be found on Medline.

    Good luck.

    Dr. Leukoma, Mar 2, 2004
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  3. Glenn Hagele - Council for Refractive Surgery Qual, Mar 2, 2004
  4. Mark

    Mark Guest

    Thank you for the great feed back. I finally know the name of my
    condition! I have a few more comments/questions:

    1) This has happened to me roughly 75 times since Lasik, and each
    time, my vision comes back without noticeable damage. I have always
    been very concerned of permanent blurry vision. Are these concerns
    valid? Should I devote more time in searching for a solution or
    should I just stay with the eye ointment? One argument for using the
    ointment is that it's worked every time. One negative is sometimes I
    forget to use the ointment (or leave it at home when I'm on travel)
    and the problem reoccurs. This can be very frustrating. My vision in
    that eye will be poor for 24 hours (I basically can't read letters
    that are 1 inch tall and 10 feet away).

    2) Is the surgical treatment you refer to common? Is the success rate
    high? In a way, what you describe makes since. Tiny punctures could
    allow the epithelium to anchor itself into the basement membrane
    increasing adhesion.

    3) It may be possible that I sleep with my eyelid open slightly. I
    will have my wife check on this. If I did, will this cause the
    epithelium to become sticky or weaker when dry?

    Thanks again.
    Mark, Mar 4, 2004
  5. Mark

    Dr. Leukoma Guest

    (Mark) wrote in

    In my opinion, stromal puncture should not be attempted in the visual axis
    because of the potential scarring. Other methods, such as debridement and
    phototherapeutic keratectomy are also available for the treatment of RCE.
    Seventy-five incidences of RCE is quite alot.
    Dr. Leukoma, Mar 4, 2004
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