Dry Eye After Refractive Surgery Can Potentially Improve From Baseline

Following FS-LASIK, patients can experience improvements from baseline in dry eye symptoms.

Dry eye after refractive surgery has the potential to not only return to baseline, but to improve at approximately 6 months after surgery, according to research published in Clinical Ophthalmology. The prospective case series is the first to report a net improvement in patient-reported dry eye symptoms after myopic femtosecond laser-assisted in situ keratomileusis (FS-LASIK).

The researchers evaluated findings from 40 patients (mean age, 30.1±3.8 years; 14 men; 80% White) who underwent refractive surgery and received care from September 2021 through October 2022 at a private practice in Texas. Patients with history of ocular surgery, corneal disease, posterior segment disease, or systemic autoimmune disease were excluded.

At baseline, patients’ eyes had a mean binocular best-corrected distance visual acuity (CDVA) of -0.10±.05 logMAR, manifest refraction spherical equivalent of -3.39±.1.58 diopters (D), and manifest refraction refractive astigmatism of 0.94±0.66 D. To evaluate dry eye after refractive surgery, patients completed a Patient-Reported Outcomes with LASIK Symptoms and Satisfaction (PROWL) survey several times, from baseline through 6 months after surgery. They could score symptoms from 1 to 5.

Researchers conducted objective scatter index (OSI), tear film osmolarity (TFO), and automated tear break-up times (TBUT) measurements.

Dry eye after refractive surgery symptom scores dropped from 2.3 at baseline to 1.3 at the end of the study. Symptoms of “grittiness,” but not “light sensitivity” or “soreness” were statistically significantly improved. However, OSI, TFO, and TBUT did not change significantly.

All patients had binocular uncorrected distance visual acuity that was at least -0.1 logMAR (mean, -0.20±-0.06 logMAR) at the end of the study. At the endpoint, absolute spherical equivalent was 0.02 D and refractive astigmatism was 0.20 D.

Researchers did not detect complications following the refractive surgeries.

“Most clinicians educate patients about the risk of dry eye symptoms and chronic dry eye conditions, but the patient-reported outcomes in this study suggest that the clinician may be able to discuss decrease of dry eye symptoms as a potential benefit of LASIK,” the study authors suggest. “This finding stands in stark contrast to some previous studies which suggest that symptoms for dry eye (using the McMonnies questionnaire) increased and did not recover after both LASIK and PRK.”

Study limitations include the lack of a control or comparison cohort.


Rush S, Pickett CJ, Rush, RB. Patient-reported dry eye outcomes after myopic femtosecond-LASIK: A 6-month prospective analysis. Clin Ophthalmol. 2023;17(7):2141–2147. doi:10.2147/OPTH.S421369