Dry eye after LASIK, PRK or SMILE

LASIK, PRK and SMILE all reshape the cornea. In doing so, they interrupt the corneal nerves that normally trigger tear production. Those nerves grow back — but for weeks to months, your basic tear reflex is quieter than it was, and the ocular surface has to compensate.

LASIK involves creating a corneal flap, which cuts more nerves than PRK or SMILE. That's why SMILE tends to have slightly less dry eye than LASIK in the short term — though good technique matters more than the technology.

Post-op inflammation, preservative-containing drops, and any pre-existing dry eye that wasn't spotted at your screening all add to the picture.

Nerves regrow, tear production recovers, and drops become a background thing. Good lid hygiene, a decent preservative-free drop and omega-3 supplementation cover most people.

• • A full dry eye assessment: tear film stability, meibography, surface staining, and corneal sensitivity testing (important post-laser).
• • Preservative-free lubricating drops matched to your tear type — not whatever's cheapest.
• • Short courses of anti-inflammatory drops if the surface is still inflamed.
• • IRPL and meibomian gland expression if the oil layer is the problem — very common after laser surgery.
• • Punctal plugs for genuinely low tear volume.
• • Autologous serum drops in the small number of cases where the surface isn't healing properly.

Uncontrolled dry eye is a formal contraindication for LASIK. If your eyes are dry now, get an assessment first — treating the surface before surgery improves the outcome and shortens the recovery. It's also a good moment to have an honest conversation about whether laser is the right option for you, or whether contact lenses or glasses with a well-treated ocular surface would suit you better.