Evaluate all patients for dry eye before refractive surgery

Key Points

"Dry eye is potentially one of the most devastating non-flap-related complications associated with refractive surgery," explained Dr. Donnenfeld. "However, the risk of this complication can be minimized with an intelligent surgical, pharmacologic, and behavioral approach to refractive surgery." He spoke during the Refractive Surgery Subspecialty Day meeting, sponsored by the International Society of Refractive Surgery of the American Academy of Ophthalmology.

"I consider these stains vital to dry eye evaluation, and I look at them like a traffic light," Dr. Donnenfeld said. "All these stains tell me to slow down or stop because the patient may not be a candidate for refractive surgery."

Who should avoid surgery?

"If a patient has dry eye symptoms but they have no effect on vision, the patient is usually a good candidate [for refractive surgery]," he said. "If a patient has dry eye symptoms and fluctuating vision, the individual is a moderate or poor candidate. For those patients with dry eye symptoms and decreased visual acuity due to ocular surface disease, they are not candidates for refractive surgery."

Dry eye signs

Patients are good candidates for refractive surgery if they have no dry eye symp toms exhibited by supravital staining of the conjunctiva. Individuals are considered moderate candidates if they have supravital staining of the conjunctiva but no corneal staining. If patients have both supravital staining of the conjunctiva and central fluorescein corneal staining, they should not undergo refractive surgery, Dr. Donnenfeld warned.