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Post-LASIK dry eye can be reduced with prevention strategies
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Refractive surgeons can take steps to help reduce the occurrence of dry eye syndrome in their patients after LASIK surgery, according to Frank A. Bucci Jr., MD.
A reduction in tear production can be expected in every LASIK patient during the months after surgery, Dr. Bucci said. But preoperative, perioperative and postoperative measures can be taken to prevent severe dry eye and to relieve symptoms if dry eye occurs.
During the preoperative work-up, the surgeon should assess the patient’s risk of developing post-LASIK dry eye. Careful history-taking, focusing on factors such as contact-lens intolerance and chronic use of anti-anxiety medication can help identify patients at increased risk for dry eye syndrome, Dr. Bucci said. Other factors that can influence postoperative results include irregular astigmatism, punctate epithelial keratopathy and allergic conjunctivitis, Dr. Bucci said.
Patients who appear to be at risk for dry eye can be treated preoperatively with transiently preserved or nonpreserved tears and ointment or punctal plugs. Before surgery, patients should undergo thorough lid cleansing to decrease endotoxins and should receive a course of anti-inflammatory drugs to reduce the occurrence of postoperative swelling. Additional ointments and nonpreserved tears can also be administered.
Dr. Bucci said attention to the characteristics of one’s microkeratome can also help minimize postop dry eye. When selecting a microkeratome, he said, the surgeon should consider the epithelial defect rate of the device. The microkeratome head should be lubricated, as should the cornea before the microkeratome pass, and the surgeon should limit the use of markers on the corneal surface.
After flap creation and corneal ablation, a tear lubricant should be placed on the flap. Patients at risk for dry eye should use tear supplements every hour for 24 hours after surgery. Punctal plugs can be implanted as needed.
Dr. Bucci will outline these and other recommendations for prevention and treatment of post-LASIK dry eye at Hawaii 2005, The Royal Hawaiian Eye Meeting, to be held on the island of Hawaii, Jan. 16-21.