Eye drops after LASIK surgery

Eye drops after LASIK surgery are an important part of your postoperative and sometimes preoperative regime. Different surgeons recommend different variations of the LASIK eye drop, but most post LASIK eye drops include the same basic elements: an antibiotic and a steroid post LASIK eye drops. Most LASIK surgeons recommend post LASIK artificial tears also. Eye drops after LASIK are essential to a safe and easy recovery after your LASIK investment.

What kind of eye drops after LASIK are there?

• Antibiotic:
  • Moxifloxacin
  • Besifloxacin
  • Ofloxacin
• Steroid:
  • Prednisolone Acetate
  • Loteprednol
  • Difluprednate

There are many other drops in the fluoroquinolone antibiotic class, but the above three are likely currently the most commonly prescribed. They have broad-spectrum coverage but unfortunately do not generally kill the MRSA (Methicillin resistant staphylococcus aureus) bacteria as well as other drops might. At SharpeVision, we sometimes add an antibiotic called Polytrim that is more effective against the MRSA bacteria. Although infection of any type is an extraordinarily rare complication, we give Polytrim to our patients who are at risk for colonization with MRSA such as health care workers in higher-risk areas of the hospital. This would include respiratory therapists, nurses, doctors, support staff, and any other workers in or around intensive care units. Anyone who has had a previous infection with or who has tested positive for MRSA also receives the Polytrim antibiotic eye drop after LASIK or PRK.

Each medication’s effectiveness evolves with the bacteria, which is concerning for any procedure, but fortunately the current antibiotics are fantastic. They allow us to do safe surgery. To put it in perspective, your risk for antibiotic infection is estimated to be 10 times higher by wearing contact lenses as compared to LASIK. There is a brief period of risk after LASIK, but with contact lenses you have that small risk continuously for the entire time you are wearing your contact lenses. The biggest risk to a corneal infection is indeed contact lenses and especially in those who wear their contact lenses while they sleep. I would strongly recommend against this. It’s not that hard to take them out and you are putting your eyes at great risk by wearing them while you’re asleep. The pH (acidity) of your eyes’ surface water/tears decreases or becomes more acidic when you are asleep. This creates an environment conducive to bacteria to grow. The bacteria can penetrate the epithelial surface of your eyes and set up shop. They replicate very quickly and can cause severe scarring or even blindness after an infection. Fortunately this is extraordinarily rare in LASIK. I would estimate it is one out of every 15,000 to 20,000 eyes we have treated has had the start of an infection, but fortunately no one has lost any vision at all because we aggressively treated them and they recovered without any ill effect.

As for the steroid eye drops after LASIK, each has a different qualities that may influence your LASIK eye surgeon’s choice of steroid for you.  Prednisolone acetate has been used for decades and has a medium-high potency, is well tolerated, comes in generic, and can be very inexpensive.  It was the gold standard for steroid eye drops until Durezol was approved. Loteprednol (Lotemax) is similarly potent to prednisolone acetate and yet has a lower incidence of intraocular pressure elevation.  Since we only recommend a steroid for a week following your LASIK procedure, this is less of an issue for LASIK and PRK. Durezol (difluprednate) is the most potent steroid on the market today. It is able to be used in half doses because it is roughly twice as potent as prednisolone acetate. It’s the steroid of choice for intense eye inflammation. It’s commonly more expensive, so at SharpeVision we don’t generally use it as our first choice for postoperative LASIK eyedrops. There are other steroid eyedrops available also, but these are the most commonly prescribed and are generally available at any pharmacy.

Eyedrops after PRK Surgery

The post PRK eyedrops are usually the same as post LASIK eyedrops. However, sometimes surgeons vary on their recommendations. Some doctors recommend a NSAID (nonsteroidal anti-inflammatory drug) eyedrops to decrease post PRK pain. This may potentially be a double-edged sword because while the pain may be better, there are some reports of slowed healing time after using an NSAID drop. This is slightly controversial among LASIK and PRK surgeons, but not usually a big issue. I have chosen not to use an NSAID as an after LASIK eye drop because of this potential slowed epithelial healing as well as increased cost and complexity.

Although the eye drops after LASIK eye surgery may vary, the additional medications that are sometimes recommended include high doses of fish oil to improve your ocular or eye surface. In my opinion these may help, and there is some evidence in the scientific literature that it does. This is not controversial because there are no downsides or side effects to taking fish oil other than the cost. There are rare reports of stomach upset (diarrhea) with high doses of fish oil. Some doctors may recommend high doses of vitamin C, especially with PRK procedures. The other eye drops LASIK may get you are short-term numbing eye drops to help with post-operative discomfort. At SharpeVision, we typically give out 20 to 30 numbing drops after LASIK eye surgery and 50 to 60 numbing eye drops after PRK surgery.

The next big category of eye drops for Lasik surgery is artificial tears. Lasik artificial tears are the same as any artificial tear drops for dryness of the eyes. That is, they are generally recommended for as long as you want and as frequently as you want for mild irritation of the eyes. Most people have some degree of dryness for anywhere from one month to six months after LASIK eye surgery. I always say “your level of dryness will return to baseline“ anywhere from 1 to 6 months after LASIK eye surgery or PRK eye surgery. People do have dry eyes regardless of whether or not they have had LASIK or PRK. I do not believe that LASIK causes long-term dryness but definitely short term increased level of dryness for anywhere from 1 to 6 months.

Dry Eyes after Eye Surgery

There is an online myth that there is less dryness after PRK surgery as compared to after LASIK surgery.

“My experience over 25 years doing the procedure is that there is no difference in the dryness after LASIK eye surgery versus the dryness after PRK eye surgery.”

I recommend artificial tears after Lasik surgery for everyone. They are easy to do and inexpensive. They give good temporary relief of the dryness that one temporarily feels after Lasik eye surgery. There are many brands including Systane, Refresh, Blink, as well as many generic brands. They all have similar ingredients. There are menthol eyedrops that generally come from Asian countries. These are fine to use also after your LASIK or PRK eye surgery, if you are healed enough to tolerate them. There are many other ways of improving the surface of your eyes after LASIK eye surgery or PRK eye surgery. They include but are not limited to:

• Punctal Plugs: Dissolving or non-dissolving and easy to put in, no maintenance and invisible, they can be a great option. They are inserted by your eye doctor in a painless (seriously, you don’t even feel it!) procedure.
• Ophthalmic Lubricating Ointment: A little more difficult to get in your eyes – I recommend running the tube under hot tap water for 20 seconds to liquefy it and make it easier to go in your eyes. It can leave your eyes somewhat greasy in the morning. I recommend washing your eyes gently as you normally would with some sort of soap, as well as using artificial tears to rinse out the ointment. There are many brands of this including Refresh PM, Lacri-Lube, and others, but you can generally get the generic version as all the ingredients are the same: mineral oil and petrolatum.
• Ophthalmic Lubricating Gel: Easy to put in your eyes, and no grease, but can dry out or leave crusty residue in the middle of the night more than ointment.
• Prescription Eyedrops for Dryness: Restasis and Xiidra
• Other less well-known therapies that generally a practitioner specializing in dry eyes can recommend.

“What eye drops after LASIK surgery are required?” is a fairly big topic, but I hope I have helped you with this summary of the categories: antibiotic, steroid, artificial tears, and other less commonly prescribed drops.

-Dr. Matthew Sharpe