If LASIK itself induces dry eye, the question arises whether LASIK can be performed safely and effectively on patients with preexisting dry eye. We conducted a retrospective study
18 in which we categorized patients into 2 groups based on information collected preoperatively—a dry eye group and a non-dry eye group—in accordance with the Japanese criteria for characterization of dry eye.
44 We then compared the incidence of complications, loss of best corrected visual acuity (BCVA), dry eye symptoms, and tear functions in the 2 groups postoperatively. We did not find any difference in the incidence of intra- and postoperative complications and loss of BCVA between the groups. We were particularly careful regarding epithelium-related complications, such as epithelial defect and epithelial ingrowth, but their incidence did not increase in the dry eye group. In contrast, dry eye symptoms and tear functions were more compromised in the dry eye group pre-and postoperatively, until 1 year after surgery. However, the symptoms and tear functions returned to preoperative levels even in the dry eye patients. For further verification, postoperative uncorrected visual acuity and refraction in the two groups were compared, but no difference was found. These results suggest that LASIK can be performed effectively in patients with dry eye. However, preexisting dry eye is a risk factor for severe postoperative dry eye with reduced tear function,
18,45 more vital staining of the ocular surface, and more severe symptoms.
18 Liang et al. concluded that severe and refractory dry eye can develop after LASIK in patients with well-controlled early-stage Sjogren syndrome.
46 Therefore, careful patient-selection should be conducted before performing LASIK on patients with preexisting dry eye. LASIK should not be recommended for patients whose ocular surface staining does not improve with preoperative treatment. Phakic intraocular lenses and SMILE might be considered as alternatives for these high-risk dry eye patients. For any type of refractive surgery, strict informed consent is mandatory before surgery.