Eyes after vision correction - how not to lose vision again. The use of drops after laser vision correction Dryness after laser vision correction

Dry eye syndrome, fluctuations in visual acuity, and foreign body sensation are temporarily worsened after both LASIK and PRK, the study found.

A systematic randomized clinical trial included 34 patients treated with wavefront-guided LASIK in one eye and PRK in the other. Before and after surgery, patients filled out questionnaires asking about the severity of dry eye symptoms, fluctuations in visual acuity, and foreign body sensation in the eye.

With both LASIK and PRK, dry eye symptoms increased significantly after surgery. One month after surgery, the severity of dry eye syndrome also increased significantly. Only three months later, the manifestations of symptoms and the values of parameters characterizing the presence of dry eye syndrome returned to the original values for LASIK and PRK.

Variations in visual acuity increased significantly over 6 months after both LASIK and PRK. This indicator returned to baseline values 12 months after surgery.

The slight increase in foreign body sensation in the eye that patients experienced one month after LASIK and PRK returned to baseline levels three months after surgery.

Material prepared by: Theochem

Thanks to scientific research, it was possible to establish that PRK and LASIK lead to the formation of dry eye syndrome with the same frequency. Previously, it was believed that LASIK caused this complication much less frequently.

The disease develops due to insufficient production of tear fluid. Multiple tears form in the outer film, leading to gradual deterioration of vision. The following reasons can provoke the syndrome:

sharp decreased estrogen levels in the body and the development of endocrine ophthalmopathy;
Sjögren's disease associated with the uncontrolled proliferation of connective tissue - provokes blockage of the water ducts of the lacrimal glands of the eye;

undergone ophthalmic surgery operations;
long stay in front of computer, at particular risk are office employees working behind a monitor 8-10 hours daily.

Symptoms include constant burning of the eyes. Due to the lack of fluid, the nerve endings send a signal to the brain to increase the production of tear fluid. Itching is felt due to the high sensitivity of the eyes, there is a deterioration in image clarity, blurring of objects.

Diagnostics

To find out how damaged the outer film is, A thorough examination is carried out by an ophthalmologist:

Analysis of patient complaints— a detailed survey often helps to find out the cause of dry eye syndrome.
External inspection- allows you to determine the condition of the eyelids and the degree of their closure, as well as determine the frequency of blinking.
Biomicroscopy method— the current state of the tear film is assessed.
Fluorescence test— the exact period of time when the tear film breaks is determined. Areas of rupture are identified using a diagnostic staining solution.
Carrying out the Schirmer test- to determine the rate of tear fluid formation.

Photo 1. Carrying out the Schirmer test: litmus paper is inserted into the conjunctival sac, which changes its color under the influence of tear fluid.

Norn's Test— determines the rate of evaporation of liquid from the surface of the eyes.
Smear for cytological examination.
If, when interviewing a patient, it turns out that he has endocrine disorders or systemic pathologies, then it is necessary consultation with an immunologist and endocrinologist.

After identifying all signs of the disease, a diagnosis is made final diagnosis And appropriate therapy is prescribed

How to treat patients with dry eye syndrome

Treatment for dry eye syndrome involves a number of steps that aimed at the gradual restoration of the tear ducts:

stimulation of tear production;
in difficult cases, artificial replenishment of eye fluid;

preventing the outflow of tear fluid;
decreased evaporation of fluid from the surface of the eye.

Depending on the complexity of a particular case, an ophthalmologist selects the appropriate technique or combination of several treatment methods:

conservative treatment;
orthopedic method;
surgical correction.

Which option is right for a particular patient? the doctor decides based on the survey results.

What drugs to use

This therapy is used for mild disorders of the tear film of the eye.

For example, if the DES disease is not caused by a hidden pathology in the patient, but arose as a result of long work at a computer monitor.

To restore the film in this case, use:

special eye drops;
gels;
ointments.

Among the frequently prescribed eye drops:

Sodium hyaluronate;
Polyvinyl alcohol;
Lacrisin;
Hypromellose.

Application of drops should be worn short-term nature. But if the treatment lasts for a long time, it is better to use drugs that do not contain preservatives and have a thick consistency.

Elements included in many medications can aggravate the course of the disease with long-term use.

Eye gels are also effective for dry eye syndrome. Carbomers are present in medications used in the treatment of dry eye syndrome:

Oftagel;
Korneregel;
Vidisik.

The drugs are designed for increased tear viscosity, on increasing its drying time. Simultaneous use of eye gel with other medications prolongs their absorption period. After applying the gel, vision may become blurred.

The ointments are based on mineral lipids and petroleum jelly. Use of these drugs for dry eye syndrome allowed for advanced forms of the disease. The drugs protect against the penetration of pathogenic bacteria into the eyeball and prevent their proliferation. Lack of medicines- blurred vision, so they are applied to the eyes before bed.

Photo 2. Packaging of Vidisik eye gel weighing 10 g. Manufacturer: Bausch&Lomd.

Taking medications for dry eye syndrome is necessary, even if surgical correction has been performed. In addition to standard eye drops that stimulate tear production, additional means to combat inflammation.

How to get rid of the blepharoconjunctival form of dry eye syndrome using physiotherapy

The blephoconjunctival form of the disease has recently been increasingly diagnosed in patients seeking help from an ophthalmologist. The main reason is advanced disease leading to a chronic form.

Physiotherapeutic techniques are used as methods of treating this type of dry eye syndrome. Exposure to electromagnetic fields during the procedure ensures:

anti-inflammatory effect;
anesthesia;
changes in electrolyte metabolism, reduction in swelling of eye tissue.

In combination with drug therapy the effectiveness of physiotherapeutic effects increases.

Can it be cured with surgery?

Surgical intervention is prescribed in an advanced state of the disease. Only an ophthalmologist prescribes surgery based on diagnostic results. Applicable:

obstruction of lacrimal ducts, i.e., reducing the outflow of tear fluid using silicone plugs;
corneal plastic surgery- in case of serious disorders, such as ulcerative formations, necrosis or perforation;
lateral tarsorrhaphy;
transplantation.

Attention! Surgical intervention is extreme measure of treatment.

The method of blocking the tear ducts with plugs is also considered effective. In this case, the formation of plugs in the tear ducts helps to reduce the outflow of fluid and increase its accumulation on the conjunctival film. Procedure prescribed for severe disturbances in the production of tear secretion or corneal degradation.

Silicone plugs can completely or partially reduce the secretion of tear fluid, it all depends on the specific case. To evaluate the effectiveness of the method, a preliminary operation is performed when self-absorbing collagen solution. If the procedure gives a good result, then after the collagen has been absorbed, the patient is injected with a non-absorbable silicone solution.

Reference. Serious corneal disorders require a more radical intervention - transplantation, when into the conjunctival sac salivary gland implantation for the production of eye fluid.

With lagophthalmos the eyelid does not completely close the eye, thereby not ensuring complete wetting of the eyeball with liquid. Here, surgical correction of this defect is used as treatment.

Dry eye syndrome as a consequence after laser vision correction

After any eye surgery, the patient is prescribed special drops that should be used before the rehabilitation period expires. This helps to avoid the development of complications.

After laser correction, dry eye syndrome progresses. The disease is especially acute a week later after the procedure.

In order to avoid unpleasant symptoms, doctors recommend undergoing an examination in advance and determining the current state of the visual system.

Ophthalmologists prescribe drugs for the production of artificial tears and various gel-like tear replacement dosage forms, which are selected by the ophthalmologist in each specific case. The most effective medications are considered Artelak Splash, Hilo-Chest, Hilozar-Chest.

How long does it take to treat the disease in adults?

If you contact an ophthalmologist in a timely manner and following all prescribed procedures, the prognosis for recovery is favorable. Already in a few days the use of drugs that promote the production of artificial tears, as well as reduce inflammation and reduce irritability of the conjunctiva, significant relief is observed.

Important! Worth sticking proper nutrition and drink plenty of fluids, visual reduce the load to a minimum.

To prevent the development of severe diseases of the cornea and conjunctiva and possible loss of vision, it is necessary to reduce the impact of artificial factors, as well as regularly carry out prevention of pathologies of the organs of vision.

Useful video

Watch a video that explains what dry eye syndrome is, its causes, and treatment.

An individual technique will speed up treatment

The use of conservative or surgical methods in the treatment of dry eye syndrome depends on the degree of disease progression. Any therapeutic technique requires careful monitoring by a physician to avoid the development of severe complications. Do not let the disease progress and contact specialists in a timely manner.

Among refractive surgeries, LASIK (Laser-Assisted in Situ Keratomileusis) is considered the most commonly performed procedure for the treatment of nearsightedness, farsightedness and astigmatism.

How does laser vision correction work?

The cornea is the part of the eye that helps focus light to create an image on the retina. It works like a camera lens that creates an image on film. Typically, the shape of the cornea is not ideal, and the image on the retina may be unfocused (blurry) or distorted. These imperfections are called refractive errors. There are three main types of refractive errors: nearsightedness, farsightedness and astigmatism.

Glasses or contact lenses are designed to compensate for visual impairments, while laser correction is aimed at improving the focusing power of the eye. The LASIK procedure reshapes the cornea so that the light entering the eye is properly focused on the retina, resulting in better vision.

Who can undergo laser correction?

For the LASIK procedure, candidates must meet the following criteria:

At least 18 years of age.

Stable vision over the past 12 months.
No autoimmune diseases: lupus, rheumatoid arthritis or multiple sclerosis.

Diabetes is not a contraindication to LASIK if the patient controls it and does not have diabetic retinopathy.

What are the contraindications for laser vision correction?

Your vision changes by more than one diopter per year.
Pregnancy, lactation and pregnancy planning in the next 6 months after surgery.
Eye diseases: keratoconus, uncontrolled glaucoma, severe cataracts, corneal diseases and some retinal and optic nerve diseases.

Are dry eye syndrome and laser vision correction compatible?

Many patients decide to undergo laser correction due to dry eyes and the inability to wear contact lenses any longer. Dry eyes may become worse after surgery because the corneal tissue is injured and produces fewer tears. This condition is temporary and usually goes away in 3-6 months. To relieve the symptoms of dryness, you can use moisturizing drops - artificial tears.

How to prepare for surgery?

Contact lenses change the shape of the cornea, so you should stop wearing them 1-2 weeks before surgery.

Do not drink alcohol 2 days before laser correction.

Is it possible to treat both eyes at the same time?

Yes, most patients have both eyes corrected at the same time.

Does laser vision correction hurt?

Before the operation, special anesthetic drops are placed in the patient's eyes. There is a feeling of numbness in the eyes. The patient may also be given a mild sedative to help them relax.

After surgery, most people experience slight discomfort, and there may be a tingling or “gritty” sensation in the eyes. These are temporary symptoms; to eliminate them, the doctor prescribes various ophthalmic drops.

How long does the operation take?

In total, on the day of surgery the patient will spend from 1.5 to 2 hours in the clinic. Of these, only 15 minutes are spent in the surgical room. The laser exposure time on the cornea is approximately 1 minute for each eye. After the operation and a short rest, the patient goes home.

How quickly does recovery occur after laser vision correction?

Immediately after surgery, your vision will be a little blurry and hazy, but it should become clearer the next morning. Vision will finally stabilize within a few days (in rare cases, it may take several weeks). Therefore, the next day after the operation, the patient is allowed to go to work, but many doctors still advise taking a couple of days of rest. In addition, it is recommended to avoid intense physical activity for a week, as this can injure the eye and affect recovery.

What restrictions are there after surgery?

Read during the day after surgery.
Drive until an ophthalmologist confirms that your vision meets the legal driving standard.
Rub your eyes, touch them with your hands.
Do eye makeup. You can resume makeup 2 weeks after surgery.
Exercise for a week after surgery.
Swim in pools for 2 weeks after surgery, and in rivers, seas and oceans for 3-4 weeks.
Drink alcohol for a month after surgery.

Are there complications after surgery?

The LASIK procedure has a low risk of short-term and long-term complications. Less than 1% of patients experience serious vision-threatening problems after surgery. The main complications of LASIK include eye infection, chronic dry eyes, and blurred vision.

Will vision remain good forever after correction?

Yes. After surgery, the treatment effect lasts for life.

Dry eye syndrome is a disease that occurs as a result of a decrease in the quality or quantity of tear fluid, causing damage to the ocular surface and a feeling of discomfort. Excessive tear evaporation (the cause of dryness in 86% of cases) is caused by obstruction or dysfunction of the meibomian glands, located on the edges of the eyelids and responsible for the production of the oily, lipid layer of tears. A deficiency or complete absence of this layer can cause the tear film to evaporate up to 16 times faster.

This is a very common disease in the world. For example, in the USA, according to various sources, it affects from 10 to 48% of the population, mainly over the age of 40. There is information that in Russia this figure is about 17% of the population, while nine out of ten patients are women. However, all these figures are relative and may not fully reflect the true situation. Thus, 69% of respondents experiencing symptoms of dry eye syndrome do not seek help from ophthalmologists about this. Women are slightly more likely to suffer from this disease. In 42% of women aged 45-54 years who report blurred vision, this symptom is associated with this syndrome. Dry eye syndrome associated with Sjogren's syndrome occurs in about 1-3% of the population, of which 90% are women.

Causes

The causes of dry eye syndrome are disruption of tear production, disruption of the process of tear evaporation from the surface of the cornea, or a combination of both. Insufficient tear production is the most common cause of dry eye syndrome. Conditions leading to this are divided into those associated and not associated with Sjögren's syndrome. Sjögren's syndrome is a chronic autoimmune process that primarily affects the salivary and lacrimal glands. It can be primary, i.e., occurring in isolation, and secondary - with other systemic autoimmune disorders of connective tissue.

Tear and its functions

Tear is a sterile, transparent, slightly alkaline (pH 7.0–7.4) liquid consisting of 99% water and approximately 1% organic (immunoglobulins, lysozyme, lactoferrin) and inorganic substances (mainly sodium salts, magnesium and calcium). The conjunctival sac, a slit-like cavity between the back surface of the eyelids and the front surface of the eyeball, contains about 6-7 μl of tear fluid. The released tear fluid, washing the front surface of the eye, flows into the inner corner of the eye and through pinhole openings (lacrimal puncta) enters the upper and lower lacrimal canaliculi. These canaliculi lead to the lacrimal sac, from where through the nasolacrimal duct into the nasal cavity. The lipid layer produced by the meibomian glands and glandular cells of Zeiss and Moll performs a protective function and prevents the evaporation of the underlying layer from the surface of the eye. Another important property is the improvement of the optical properties of the cornea. Dysfunction of the lipid layer can lead to increased tear evaporation.

The meibomian glands are located in the thickness of the upper and lower eyelids and secrete secretions through the excretory ducts, creating an oily film on the surface of the eye. This layer prevents the evaporation of moisture from the surface of the eye and protects the eye from overheating and hypothermia.

What is the relationship between the work of the meibomian glands and dry eye syndrome?

When the functioning of the glands is disrupted and the oily secretion is insufficient, increased evaporation of the tear film occurs, and the surface of the eye begins to be damaged. This provokes the symptoms of “dry eye”.

sensation of a foreign body in the eye
sensitivity to light (photophobia)
discomfort
redness of the eyes
change in vision
burning

Symptoms are worse in windy, dry, and air-conditioned conditions.

WHY IS THE FUNCTION OF THE MEIBOMIAN GLANDS DISRUPTED?

Decrease in androgen levels with age, including postmenopause;
Involutional (age-related) decrease in the secretion of the meibomian glands;
Seborrheic and atopic dermatitis, rosacea, etc., when the meibomian glands are affected along with the sebaceous glands of the skin;
Exposure to chemicals, including certain medications (eg, antihistamines);
Chronic blepharitis, use and abuse of eye cosmetics, use of contact lenses, eyelash extensions;

Large visual load (computer, TV, reading).

Why is dry eye syndrome dangerous?

In the absence of timely treatment, the condition can develop into a severe chronic process, in which areas of “drying out” on the cornea can turn into persistent opacities. At the same time, vision is significantly reduced, and treatment with drops may no longer be sufficient. Restoring the transparency of the membrane in such cases occurs through a corneal transplant.

Treatment

The main areas of treatment for dry eye syndrome are reducing the factors that provoke the disease, stimulating tear production and compensating for its deficiency, increasing the time tears remain on the surface of the eye, eyelid hygiene and treatment of inflammatory processes. Treatment tactics depend on the severity of the disease and may include conservative and surgical methods. Changing the patient's living conditions can play an important role. Early detection and aggressive treatment of dry eye syndrome can help prevent corneal scarring and ulceration. The prognosis depends on the severity. Most patients have mild to moderate symptoms, the symptoms of which can be successfully managed with symptomatic instillation of tear substitutes. In general, the prognosis for visual functions is favorable. However, in patients with Sjogren's syndrome or who have not received treatment for a long time, it is less favorable, and DES in them requires a long course of therapy.

Occlusion of tear ducts

This method is often effective (in 74-86% of cases) and a safe method even in childhood in the presence of persistent symptoms of dry eye syndrome that are not relieved by tear substitutes. Its essence is to block the natural outflow of tear fluid through the lacrimal openings. Only the lower or upper lacrimal openings can be blocked, but in some cases both at the same time. Typically, absorbable obturators are implanted first, followed by non-absorbable ones if necessary. Obturators can be installed in the initial part of the nasolacrimal canaliculus (lacrimal punctum) or deeper along the canaliculus (intracanalicular). Their sizes, depending on the diameter of the tubule, can range from 0.2 to 1.0 mm.

Surgery

Surgical treatment is indicated in very severe cases with the formation of corneal ulcers or the threat of perforation.

Surgical treatment methods include:

1) fixation of perforation or descemetocele with cyanoacrylate glue;

2) covering the site of possible or obvious perforation with a corneal or corneal-scleral flap, for example, from amnion tissue or fascia lata;

3) lateral tarsorrhaphy (indicated in patients with secondary dry eye syndrome after keratitis as a result of damage to the facial or trigeminal nerve);

4) covering the lacrimal opening with a conjunctival flap;

5) surgical occlusion of the lacrimal drainage system;

6) transposition of the salivary gland duct;

7) cryo- or thermocoagulation of the lacrimal opening.

One of the new methods of surgical treatment of dry eye syndrome caused by dysfunction of the meibomian glands is probing of the meibomian glands.

How to treat dry eye syndrome?

eyelid hygiene (carried out with the aim of emptying the meibomian glands, restoring the lipid component of the tear film, cleansing the skin of the eyelids, improving blood circulation, which, in turn, reduces the level of inflammatory and allergic reactions);
compensation of the lipid layer of the tear film (use of tear substitutes);
obstruction of tear outflow - the use of special “obturator plugs” of lacrimal openings;
elimination of the etiological cause of the disease (inflammatory or toxic-allergic factor);
eyelid massage (manual massage using glass rods, hardware massage using the BlephEx device);
Laser treatment with device « EYE-LIGHT.” The therapeutic effect is based on the photostimulating, immunostimulating, anti-inflammatory, absorbable, neurotrotropic effect of laser radiation.

HOW THE “EYE-LIGHT” LASER WORKS

This is the only device with two patented technologies.

"OPE" - technology: This is the effect of polychromatic light, which, thanks to thermal impulses, normalizes the functioning of the meibomian glands. The area of light irradiation is the cheekbones and the periorbital region, thereby stimulating the contraction of the glands, increasing the volume of lipids entering the tear film and reducing its tendency to rapid evaporation.

LIGHT MODULATION technology: This is a unique photobiomodulation technology used for many years in various fields of medicine (dermatology, dentistry, etc.). A beam of light of a certain wavelength causes endogenous heating of the eyelids, which facilitates the softening of the fatty secretion contained in the meibomian glands and its evacuation to stabilize the lipid layer of the tear.

Procedure name

Laser two-phase treatment of “dry eye syndrome” using the “EYE-LIGHT” device (Espansione Group, Italy). The first phase is exposure to polychromatic light to stimulate the production of meibomian glands using OPE technology. The second phase is the use of “LIGHT MODULATION” technology to improve the excretory function of the meibomian glands by softening the compacted fatty secretion.

The number of procedures depends on the severity of the condition.
1 to 4 procedures are recommended.
Procedures are carried out every 15 days.

Friends and partners

Dmitry Dementiev and Dr. Miguel Padilia Founder of the Brazilian Association of Refractive and Cataract Surgery, pioneer of the use of phacoemulsification with elastic IOL implantation in Brazil. Miguel Padilia is an internationally recognized leader in refractive surgery

Stephen Obstbaum, Professor at New York University (USA) Pioneer in the development of modern cataract surgery - phacoemulsification, Lifetime editor-in-chief of the journal "Jornal Cataract and Refractive Surgery"

Kenneth Hoffer (Professor, UCLA University, Los Angeles, USA) Kenneth Hoffer (Professor, UCLA University, Los Angeles, USA) - Founding President of the American Society of Refractive and Cataract Surgery, Pioneer of the use and development of phacoemulsification surgery cataracts and intraocular elastic artificial lenses

George Baikoff, MD and Dimitrii Dementiev, MD Anterior Chamber Phakic IOL (Vivarte) against Posterior Chamber PhakiC IOL (PRL) / Munich, 2003 year

To combat all possible undesirable consequences and speed up the healing process, doctors usually prescribe several types of drops:

Antibacterial (often with an antihistamine or glucocorticosteroid component) - they are instilled starting from the day of the operation and thereafter for a week. Then they go to the doctor to assess healing and possibly change the medication.
Moisturizing - they are used for a month or longer.

It is important to follow the following rule: when prescribing different drops at the same time, it is necessary to leave an interval between instillations of at least 20 minutes.

You should see a doctor if:

Purulent discharge from the eyes appeared. After surgery, mucous discharge. The appearance of pus means that the prescribed antibacterial drops do not act on the existing pathogenic microflora.
Allergy manifestations occurred in the form of burning, hyperemia of the cornea and eyelids, itching, and copious mucous discharge.

Moisturizing drops are similar in composition to tear fluid; they replenish its deficiency and protect the cornea from drying out. Some of them may contain substances that heal microtraumas of the cornea.

Drugs that are prescribed for a month or longer:

In addition, Oftalmoferon may be prescribed. It fights viral infection and inflammation, and hypromellose in its composition eliminates dry eyes.

Antibacterial drops are usually used in the postoperative period Tobradex and Dexamethasone.

All medications and treatment regimens are determined by the doctor.

How to instill correctly

Step-by-step instruction:

Hygiene first: Wash your hands thoroughly with soap.
Take a comfortable position: it is better to lie down or sit on a chair with a high back. Tilt your head back and look up. Now pull back the lower eyelid with your fingers and drop 1 or 2 drops into the resulting bag.
Relax: close your eyes and lie down for another 3-4 minutes.
After the procedure: do not blink, do not rub your eyes, and do not touch them with your hands at all.

Remember the general rules for handling eye drops:

Screw the cap on tightly after each use to prevent contamination of the solution.
Do not touch the tip of the dropper to your eyes.
Keep the medicine in the correct place.
Do not use an open bottle for more than a month, unless otherwise indicated in the instructions.
Don’t skimp on your health: throw away any drops left after treatment.
One person – one package of eye drops. The bottle must not be used by anyone else, even if they are members of the same family.

Useful video

Vision is restored up to 90%