Photorefractive Keratectomy (PRK) is a laser eye surgery that reshapes the cornea to correct vision problems such as nearsightedness, farsightedness, and astigmatism. A frequent concern for individuals considering PRK is the potential for developing dry eye symptoms. While dry eyes can occur after this procedure, the condition is often temporary and manageable.
How PRK Can Lead to Dry Eyes
PRK can lead to temporary dry eye symptoms primarily due to the disruption of corneal nerves during the procedure. These nerves play a crucial role in sensing the eye’s surface and signaling the brain to produce tears, maintaining adequate lubrication. When these nerves are temporarily damaged or altered, this vital feedback loop is interrupted, resulting in a reduction of tear production.
The PRK procedure involves the complete removal of the corneal epithelium, the outermost layer of the cornea, before the laser reshapes the underlying corneal tissue. This surface ablation and subsequent healing process can further contribute to tear film instability and a temporary decrease in tear flow. This effect is typically transient, as corneal nerves have a capacity to regenerate. Corneal sensation generally recovers to near-normal levels within approximately three months, though full nerve regeneration can take up to six months or even longer.
Addressing Dry Eye Symptoms After PRK
Individuals may experience dry eye symptoms following PRK, including a gritty sensation, burning, redness, blurred vision, itching, or increased sensitivity to light. These symptoms often improve as the eye heals over several months, with most patients reporting significant improvement within six to twelve months post-surgery.
Management often begins with over-the-counter preservative-free artificial tears, which should be used regularly to keep the eyes moist and comfortable. For persistent or more severe dry eye, healthcare providers may recommend prescription medications like cyclosporine ophthalmic emulsion or lifitegrast ophthalmic solution. Supportive measures also provide relief, including:
Applying warm compresses to promote tear production.
Using humidifiers in dry environments.
Consciously blinking more frequently, especially during extended screen time.
Inserting punctal plugs into the tear ducts to slow tear drainage.
Staying well-hydrated and incorporating omega-3 supplements.
PRK and LASIK Dry Eye Risk
Both PRK and LASIK can lead to temporary dry eye symptoms. However, the way each procedure impacts the cornea’s nerve structure contributes to differences in dry eye risk. PRK involves removing the surface layer of the cornea, which primarily affects the superficial corneal nerves. In contrast, LASIK requires the creation of a corneal flap, a process that severs more corneal nerves located deeper within the cornea.
Due to this difference in nerve disruption, PRK is generally associated with a lower long-term risk of severe or chronic dry eye compared to LASIK. Studies indicate that the risk of developing dry eye disease can be significantly higher after LASIK than after PRK at six months post-surgery. While initial dry eye symptoms might be more pronounced or last slightly longer with PRK due to the surface healing process, corneal nerve regeneration often occurs more rapidly after PRK than after LASIK.