Cataract surgery and laser refractive surgery (LASIK, PRK, SMILE) are two of the most successful operations in modern medicine. But there is one side effect that almost nobody warns you about clearly: your eyes are going to feel dry, gritty and tired for a while afterwards — and for a meaningful minority of patients, that dryness never fully goes away on its own.
Why surgery causes dry eye
Both cataract and laser surgery temporarily interrupt the normal tear system in three ways:
- Corneal nerves are cut. These nerves normally tell your brain "produce more tears." When they are cut or reshaped, that reflex is quieter for weeks or months.
- The ocular surface is inflamed by the procedure itself and by the drops used around it.
- Existing dry eye that nobody spotted before surgery gets unmasked — and about 80% of people booked for cataract surgery already have some surface damage, whether they feel it or not.
That is why up to 95% of LASIK patients report gritty, uncomfortable eyes early on, and around 20–40% still have dry eye symptoms six months later. After cataract surgery, more than 87% of patients are using artificial tears one month post-op.
For most people, it settles
The nerves regrow, the surface calms down, and drops become an occasional thing rather than a daily habit. If you had healthy eyes going in, that is the likely story.
For some, it doesn't — and here's the shortlist of things that help
If your eyes are still burning, blurring or watering months after surgery, this is a treatable problem, not something you have to live with. A good plan usually involves:
- A proper assessment first — measuring tear film stability, meibography of the oil glands, and the state of the corneal surface. This tells us whether the dryness is aqueous-deficient (not enough tears), evaporative (oil layer failing), or a mix.
- Preservative-free lubricating drops matched to your tear type — not the cheapest thing on the pharmacy shelf.
- Short courses of anti-inflammatory drops to calm the surface if it hasn't reset.
- IRPL (Intense Regulated Pulsed Light) and meibomian gland expression when the oil layer is the bottleneck — one of the most useful tools we have for post-surgical evaporative dry eye.
- Punctal plugs when tear volume is genuinely low, especially in Sjögren's or age-related cases.
- Coordinating with your surgeon if you're still inside their follow-up window.
What to do before surgery, if you haven't had it yet
If you have cataract or laser surgery coming up and you already know your eyes feel dry, get an assessment first. Two reasons:
- Pre-existing dry eye affects the measurements used to plan the procedure — including the lens power for cataracts and the corneal shape for LASIK. Treating the surface first can genuinely improve your outcome.
- Going into surgery with a stable ocular surface means the post-op recovery is shorter and more comfortable.
Uncontrolled dry eye is a formal contraindication for refractive surgery for exactly this reason.
When to book
If you are more than three months out from surgery and your eyes are still uncomfortable, or if you have surgery on the horizon and want to be in the best possible shape for it, a full dry eye assessment is worth doing. You can book one on the booking page.