So, can I have laser eye surgery with dry eyes? Well, the answer is ‘it depends’. It depends on the degree of dry eye. So, I do encounter some patients who had the assessment and find that they have incredibly severe dry, despite not wearing contact lenses, and despite appropriate behaviour modifications and use of lubricants and so we’re in that situation I wouldn’t undertake laser eye surgery.

We know that laser eye surgery causes a temporary increase in dry eye symptoms. Typically, this lasts about three to six months, and it results because we’re interrupting the nerves of the front of the cornea and that reduction sensation results in a reduction in tear production. Now, the nerves recover, then the nerves that do grow back in the sensation returns to normal. When it does, the tear production will also return. But if you have a patient with a very severe dry eye, they’re going to have a rough time for a few months afterwards, and I would counsel them against it. So, it’s rare to have a patient whose eyes are so dry that we can’t perform laser eye surgery.

For most people, the dry eye is a result of wearing contact lenses and staring too much at screens and air-conditioned offices. We can improve those things. So with a period not wearing contact lenses, using lubricants, changing behaviours, we can improve the ocular surface to a point where they are fit for laser eye surgery. We then manage them through the post-operative period with increased topical lubrication, increased artificial tears until the corneas are recovered, the nerves are back in, sensations are back to normal, and functions are back to normal.

Moreover, we now have access to SMILE keyhole laser eye surgery and using this approach to laser eye surgery to treat short-sightedness, we can have less effect on the dry eye. So with SMILE laser eye surgery, we’re placing incisions lower down in the corneas, they have less effect on the nerves, and we’re using a tiny keyhole incision. So again, less effect on the nerves. What this means that corneal sensation returns to normal after only about three months instead of the six months required after LASIK. And so, after LASIK, or indeed SMILE, we can manage those patients through until the tear film returns to normal and then there’s a win for these patients not wearing contact lenses anymore. Because we know that contact lenses cause dry eyes and so actually many of these patients can look forward to having improved eye symptoms long-term after they’ve had their laser eye surgery.