LASIK, or Laser-Assisted in Situ Keratomileusis, is a common outpatient procedure performed to correct refractive errors like nearsightedness, farsightedness, and astigmatism. You are generally not put into a deep, unconscious sleep for this procedure. Instead, the protocol focuses on keeping the patient awake and comfortable using local anesthesia and mild anti-anxiety measures. This approach is fundamental to the procedure’s success and is designed to be quick, minimally invasive, and painless.
The Standard Approach to Anesthesia
Pain control during LASIK primarily uses local anesthesia delivered through topical eye drops. These numbing drops, often containing agents like proparacaine, are applied directly to the eye surface before the procedure to ensure the patient feels no pain as the surgeon works on the cornea. Since the surgery is brief and involves only the superficial layers of the eye, this localized numbing is sufficient to block pain signals.
Many patients are also offered a mild oral anti-anxiety medication, such as a low-dose sedative like Valium (diazepam). This pill is taken shortly before the procedure to help the patient relax and ease any nervousness. The dose is intentionally low, designed to reduce anxiety without causing the patient to fall asleep or become unresponsive. This combination of topical anesthesia for pain and oral medication for relaxation is the standard pharmacological protocol.
Why Deep Sedation is Avoided
Deep sedation or general anesthesia, which induces unconsciousness, is actively avoided during LASIK because the procedure requires patient cooperation. The surgeon needs the patient to remain still and fixate their gaze on a specific target light while the laser reshapes the cornea. This steady visual fixation is necessary to ensure the precise application of the laser treatment.
Although modern LASIK lasers incorporate sophisticated eye-tracking technology, patient stillness remains a major factor in procedural accuracy. Avoiding general anesthesia also significantly reduces overall health risks, such as complications with breathing or heart rate, and allows for a much quicker recovery time. Since the total laser time is often less than a minute per eye and the surgery is not painful, the risks and prolonged recovery associated with general anesthesia are avoided.
What to Expect During the Procedure
Once the numbing drops have taken effect, a small instrument called an eyelid speculum is used to gently hold the eyelids open, preventing blinking during the surgery. While the eye itself is numb, the eyelids are not, which can create a slightly odd sensation. The first step involves creating a corneal flap, typically done using a microkeratome blade or a femtosecond laser.
During the creation of the flap, a suction ring is applied to the eye, which causes a feeling of pressure and a temporary dimming or darkening of vision. This pressure is typically the most uncomfortable part of the entire process, lasting only a few seconds. As the excimer laser works to reshape the underlying corneal tissue, patients often hear a distinct clicking or buzzing sound. This laser treatment is remarkably fast, often lasting less than 60 seconds per eye, and patients usually feel no sensation during this corrective phase.
Medication and Comfort Post-Surgery
Immediately following the procedure, patients commonly report sensations of grittiness, watering, and mild burning. This discomfort begins as the numbing drops wear off, typically 30 to 40 minutes after surgery. To manage these initial symptoms and promote healing, the patient begins a regimen of prescription eye drops.
This post-operative medication typically includes antibiotic drops to prevent infection and anti-inflammatory drops to control swelling, used multiple times a day for about one week. Over-the-counter pain relievers, such as ibuprofen or acetaminophen, are usually sufficient to manage any mild pain. Patients are also instructed to rest with their eyes closed for several hours and must wear protective eye shields or goggles while sleeping to prevent accidental rubbing.