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PRK and dry eyes - many questions, few answers

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  • PRK and dry eyes - many questions, few answers

    Hi there.
    About 1 year ago i got ASA (which is basically PRK) treatment on both eyes, which left me with some really uncomfortable dry eyes. My story can be read elsewhere, so I'll start out by asking some questions instead, since I have a lot of them, and so far, I've only found answers for a few.

    1) Is it possible to get dry eyes from PRK (which was supposed to be easier on the eyes than LASIK), as well as a prescription of only about -2.00? I thought this was close to fool-proof, with a small prescription as well as a surface treatment of the eyes?

    2) Psoriasis and dry eyes? I haven't found much on this on the internet, but many on this page seem to have some kind of autoimmune disease, so I wondered if my psoriasis might have anything to do with this? Also, I find it funny that Ciclosporin, the active ingredient in Restasis, is also used in the treatment of psoriasis. Is there a connection, or am I grasping for anything?

    3) Inflammation. My eyes feel inflamed, they burn. I don't see much myself though, there might be some redness on the rim of the eyelids, and sometimes I get some minor redness in the scleras themselves, though that usually fades. Is it possible to have inflamed eyes without any objective signs? Are there always clear-cut observable signs in a dry eye condition?

    4) I still have -0.5 in my left eye after surgery. My doc says it's "accomodation spasm" and not refractive error per se. He says it could be years before it may go away. Is this a phenomenon anybody has heard of before, or is he just pulling my leg since I'm still nearsighted on that eye after surgery?

    If patients or pros can answer some of the above, I'd be very grateful, so I thank you in advance.

  • #2
    Hi there,

    1. ASA is very similar to LASEK, which can cause dryness, but often less than LASIK. More commonly, it is associated with recurrent corneal erosions.
    2. I am not aware of general psorasis causing dry eye, unless the psorasis effects the surface of the eye, or the lids.
    3. Dry eyes can often be objectively seen and graded, not by the naked eye however. Do you use drops?
    4. Accommodative spasm is often a fluctuating condition, basically the focusing system of your eye is "stuck". In order to test for it, a dilating drop can be used, which relaxes the focusing system of your eye, and your true refractive state can be identified. Ask for pre-drop refraction and the post drop refraction, this will clearly show if there is an accommodative spasm.

    As a side note, -0.5D is not a lot, and it maybe your doctors way of saying, its not in your best interest to have further treatment, although if thats the case, its a bad way of saying it.

    regards,

    Ahmed.

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    • #3
      Thanks for your answers, Ahmed.

      I've no psoriasis around my eyes, luckily, I was just wondering why I had developed these dry eye symptoms after ASA, when I thought I was very much on the safe side - guess I was wrong.

      I'm not using drops very frequently, mostly because it only grants me temporary relief for a minute or so, so it seems a waste of time and money. I do use a thick lube once or twice a day, with some but limited success.

      They did use the muscle relaxant drops/dilating drops to determine the spasm. But is it possible to have accomodation spasm in only one eye and not the other, even though the nearsightedness on both eyes was nearly the same beforehand? Seems odd that it only affects one of my eyes.

      I'll definitely not have another treatment regardless. I don't want to "see" with -0.5 in one eye either, and I do have some astigmatism in both eyes as well, so once my last eye (the one that was reoperated about 3-4 months ago) has settled, I'll go and get some glasses. My laser doc told me I shouldn't get glasses, but I don't really care. I'm sick and tired of faces and text in the distance being blurred and unfocused, and glasses do fix that for me.

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      • #4
        Hi,

        I thought your treatment was 1 year ago, if it was only 3-4 months ago, its still early days.

        good luck and keep us informed.

        Ahmed.

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        • #5
          The initial treatment was 1 year ago, but 3 months ago I had a re-treatment of the right eye since it was still at -0.75.

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