Photorefractive Keratectomy (PRK) is a laser eye surgery that corrects refractive errors like nearsightedness, farsightedness, and astigmatism. Unlike LASIK, PRK reshapes the cornea’s surface without creating a permanent flap. This makes it a viable option for patients with thinner corneas or active lifestyles. The procedure achieves long-term vision correction by precisely removing microscopic tissue from the corneal surface. Understanding the process and subsequent healing period is important for managing expectations regarding discomfort and recovery.
Sensation During the PRK Procedure
The surgical process is typically pain-free, accomplished through topical anesthetic drops that numb the eye’s surface nerves. These numbing agents are administered multiple times before the laser treatment, sometimes causing an initial sensation described as icy cold.
Once the eye is numb, an eyelid speculum is placed to gently hold the eyelids open and prevent blinking. Positioning the speculum may cause slight pressure, but the numbing drops prevent sharp pain. The surgeon then removes the cornea’s outermost layer, the epithelium, sometimes using a brush-like tool.
During epithelium removal, patients may feel a dull pressure or scrubbing sensation, but not pain, since the nerves are blocked. When the excimer laser reshapes the underlying corneal tissue, the process is quick, often lasting less than 60 seconds per eye. Notable sensations include the sound of the laser (a loud whirring or clicking) and a distinct odor. This odor is the release of carbon atoms as the ultraviolet laser vaporizes tissue without heat, not the sensation of burning.
Managing Acute Post-Operative Discomfort (Days 1-3)
Discomfort begins several hours after the procedure, typically within 4 to 12 hours, once the topical anesthetic drops wear off. This initial acute recovery phase involves significant physical discomfort as the body regenerates the corneal epithelium. The sensation is commonly described as severe burning, profound grittiness, or feeling as though sand is rubbing against the eye.
To mitigate this intense healing period, a therapeutic bandage contact lens is immediately placed on the eye. This specialized soft lens acts as a physical shield, protecting the exposed corneal nerves from the mechanical friction of the eyelid during blinking, which significantly reduces pain. Acute discomfort tends to peak between 24 and 48 hours post-surgery, aligning with the initial stages of epithelial regrowth.
Patients receive a comprehensive pain management strategy that extends beyond the protective lens. This strategy often includes prescribed oral medications, such as strong non-steroidal anti-inflammatory drugs (NSAIDs) or, in some cases, a short course of narcotics. These systemic medications are taken on a set schedule to control pain rather than waiting for it to escalate.
A regimen of medicated eye drops is also used to manage inflammation and prevent infection. This includes antibiotic drops, anti-inflammatory steroid drops, and frequent use of preservative-free lubricating drops to keep the ocular surface moist. Some clinics provide a short-acting topical anesthetic drop for limited use, offering temporary relief during the most painful periods. By Day 3, the epithelial layer often begins to cover the treated area, and the most significant discomfort usually subsides.
The Recovery Timeline: Vision and Healing Milestones
Once the acute discomfort of the first few days passes, recovery transitions to visual recovery and long-term healing of the corneal surface. The therapeutic bandage contact lens is typically removed by the surgeon between Day 5 and Day 7 post-surgery. By this point, the epithelial layer is usually intact, marking the end of the most intense healing period and allowing functional vision recovery to begin.
Initial functional vision may be adequate for basic tasks, but vision is commonly hazy, blurry, and fluctuating throughout the day. Patients are usually cleared to attempt driving and return to work within the first week, though visual acuity may be below optimal. Glare, halos, and starbursts around lights, particularly at night, are common experiences resulting from the corneal surface still smoothing out.
Throughout the first month, vision continues to improve steadily, but clarity may fluctuate significantly day to day. This occurs as the epithelial cells mature and the cornea remodels its shape. Follow-up appointments are scheduled frequently to monitor corneal healing and adjust the steroid drop regimen, which is important for preventing corneal haze.
Final vision stabilization is a gradual process extending beyond the first month, often taking three to six months to achieve the final visual outcome. Initial side effects like haze and glare usually diminish as the cornea fully settles into its new curvature. Continued use of lubricating drops and protection from UV light remain important throughout this extended stabilization period to support the health of the newly corrected eye.