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LASIK (Laser-Assisted In Situ Keratomileusis)-Induced Dry Eye Most Likely Caused by Severing of Corneal Nerves SAN FRANCISCO, CA -- June 1, 2001 -- The problem of dry eye after LASIK (laser-assisted in situ keratomileusis) is most likely the result of the severing of corneal nerves (LASIK-induced neurotrophic epitheliopathy, or LNE) when the flap is made, rather than diminished tear production as previously thought. This is the conclusion of a study by Steven E. Wilson, M.D., in the June 2001 issue of Ophthalmology, the clinical journal of the American Academy of Ophthalmology, the Eye M.D. Association. In this retrospective case control study, individual eyes of 19 patients with moderate-to-severe erosions on the surface of the cornea (epithelium) at one to three months following LASIK were compared to eyes of 19 patients who did not develop epithelial erosions on the corneal flap. No patients who had significant signs of dry eye prior to surgery were included in the study. The comparison of the two groups of patients revealed no difference in tear production at one, three, or six months, and no significant difference in corneal irregularity or refractive correction, though some patients had a temporary decrease in visual acuity. What was found, according to Dr. Wilson, Department of Ophthalmology, University of Washington in Seattle, was "the signs and symptoms of LASIK-induced neurotrophic epitheliopathy tend to resolve at approximately six months after surgery." Other studies have shown that on average this is when corneal nerves complete regeneration into the flap. Dr. Wilson also points out that approximately four percent of patients who have LASIK develop the LNE-associated epithelial erosions, which "may interfere with vision in some patients." Patients who have dry eye disease prior to LASIK are more likely to develop LNE and have more severe outcomes. He also says, "it is unknown whether LNE is attributable to diminished neurotrophic factors released from the nerves or some other factor such as a decrease in the frequency of blinking." He calls for further study "to clarify the mechanism and the association with the return in corneal sensation." Dr. Wilson emphasizes the importance of warning these patients that "LASIK enhancement will likely be associated with a return of the symptoms and signs of LASIK-induced neurotrophic epitheliopathy," and he advises in these cases that "enhancement be performed in one eye at a time, separated by at least six months so the patient's visual function is maintained." SOURCE: American Academy of Ophthalmology E-mail this page to a friend or colleague! To print, use this version