Can chronic eye dryness be caused by TransPRK surgery?

Question

Hello doctor,

I was diagnosed with chronic eye dryness a few years back. My eyes, particularly the right eye, felt dry, quite red and itchy, and always sticky when I woke up. I was prescribed an antibiotic drop for about a month and lubricating drops or gels for months afterward. These symptoms persisted for about two years after the diagnosis (I stopped using contact lenses regularly since the diagnosis, and I used to wear them on a daily basis for 2 to 3 years prior). Thankfully these symptoms gradually subsided. I do get the occasional dryness every now and then, but not nearly as bad as it was a few years back. Now I have done some evaluation tests for corrective surgery, and my doctor recommended, based on the evaluation, that I opt for TransPRK using Schwind Amaris. I want your opinion judging by my history and attached evaluation results, if I am at risk of developing chronic eye dryness or other issues due to this surgery. Appreciate your feedback.

Answer 1

Hello,

Welcome to icliniq.com.

I read your history and went through your assessment data, and here is my point of view. To start with, you have to understand that dry eye is a chronic condition, and unless you have been treated with the only existing agent for the treatment of such a condition (Restasis), it will continue to exist and worsen in the future. The improvement that you have experienced is related to the discontinuation of contact lens wear (one of the main reasons that make dry eye worse) and the usage of lubricating eye drops, which I hope you continue to use. The second topic that should be addressed is your choice of refractive error correction. Although PRK, whether done with Schwind or any other approach for that matter, is a procedure that minimally induces dryness of the eyes when compared to LASIK or any other method that requires the construction of a flap prior to laser correction, nonetheless, it still is inferior to other existing methods such as SMILE laser correction. Of course, preoperative insertion of punctum plugs could assist with dry eye, but nonetheless, this condition is there to stay. Unfortunately, I did not find any data on your dry evaluation - Schirmer test, TBUT, and others that help evaluate the dryness severity. To finalize and to give you my recommendations, I would like to remind you that you will enjoy the results of this operation only for seven more years when you become 40, after which your refraction will start changing again and because the thickness of your cornea will be changed, reoperation with a laser to correct your refraction might not be possible. I would advise you to see a doctor that implants ICL (implantable collamer lens) and go for that type of refractive surgery because when your refraction changes after 40, it would be possible to take out the implanted lens and substitute with another one that meets your needs plus this type of surgery will not induce more dryness than you already have. The Keratotopography reports show that your anterior chamber's depth permits you to have such a procedure so take it into consideration before you go for that transPRK.