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Dry eye disease (DED) is a commonly encountered diagnosis in ophthalmology, but is poorly understood, difficult to define, and lacks a unique diagnostic test. The International Dry Eye Work Shop (DEWS) recently defined DED as "a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. It is accompanied by increased osmolarity of the tear film and inflammation of the ocular surface"[1]. It can be caused by either inadequate tear production or excessive tear evaporation. Dry eye symptoms range from mild ocular irritation to severe discomfort, photophobia and vision loss. Clinical signs of dry eye include evidence of decreased aqueous tear production, decreased tear volume on the ocular surface, increased rate of tear evaporation, and increased tear osmolarity. There is often a mismatch noted between the severity of signs and symptoms in patients with dry eyes.
Laser-assisted in situ keratomileusis (LASIK) is a safe and effective surgical option for treatment of refractive errors [2]; however, dry eyes are a remarkably frequent consequence of LASIK surgery, with up to 95% of patients experiencing symptoms of dry eyes after corneal refractive surgery [3]. Although signs and symptoms of dry eyes are most common in the immediate postoperative period and are usually only transient in nature, a small proportion of individuals develop chronic and severe dry eyes that can be quite refractory to traditional dry eye treatments.
The epidemiology, pathophysiology and treatment options for dry eye after LASIK will be reviewed here in an effort to improve the understanding of the etiologic factors and our ability to minimize development of severe dry eyes, and improve treatment of post-LASIK dry eyes. Through improved understanding of iatrogenically induced post-LASIK dry eyes, it is hoped that we will also expand our understanding of the pathophysiology of other forms of DED as well.
Epidemiology
Dry eye symptoms are fairly common in patients prior to LASIK, very often due to dry eye-associated contact lens intolerance leading patients to seek alternate methods of refractive error correction. The prevalence of dry eye symptoms prior to undergoing LASIK is estimated to be between 38 and 75% [4,5].
Post-LASIK, it has been widely shown that a majority of patients...