Post-Laser Dry Eye: Dr. David Robinson Explains the Causes

Gritty, tired or stinging eyes after LASIK, PRK or SMILE can be unsettling, but some dryness is a well-recognized part of early healing. The dryness often improves as the surface of the eye recovers, although the timing varies from person to person. In an interview, Dr David Robinson, a Sydney ophthalmic surgeon with more than 25 years of experience in cataract, corneal and refractive surgery, outlined the main causes.

Let’s discuss them.

Why Do My Eyes Feel Dry When They Never Did Before?

The most common explanation involves the nerves of the cornea (the clear dome at the front of the eye). These fine fibers tell the brain when the surface is drying, which prompts blinking and tear release. Laser treatment cuts through some of them, so the signal weakens.

Dr. David Robinson describes this as the main driver of early dryness. The eyelid glands may make fewer tears and blink less often, yet the person only senses that something feels off. Nerves regrow slowly, which is why symptoms can linger for a few months in some patients.

Why Does My Vision Blur and Then Clear When I Blink?

This pattern usually points to an unstable tear film. Tears are made of oil, water and mucus, and the mucus helps them spread evenly. Goblet cells (small cells on the white of the eye that produce this mucus) may be affected by the suction ring used to steady the eye during LASIK flap creation.

With fewer working goblet cells, the tear film can break up sooner between blinks. A blink resets it briefly, which is why the blur may clear and then return.

Is LASIK More Likely to Cause Dry Eye Than SMILE or PRK?

It probably does, although dryness should rarely be the critical factor driving the choice of procedure. LASIK involves a corneal flap, which severs more nerve fibers. SMILE works through a lenticle (small sliver of corneal tissue) extraction which also disturbs some, but less, corneal nerves. PRK has no flap, but the surface layer is removed, so healing follows a different pattern in the first weeks.

The size of the correction also counts. A stronger prescription means more tissue is reshaped in a deeper ablation. Ask how your own prescription and chosen procedure relate to dry eye risk.

Could I Have Had Dry Eye Before Surgery?

Quite possibly. Many people go into surgery with mild dryness they have never put a name to, partly because contact lenses can hide it for years. Dr. David Robinson notes that blocked or underperforming oil glands along the lid margin (known as meibomian gland dysfunction) often sit behind stubborn symptoms.

When the oil layer is poor, tears evaporate quickly, and the nerve changes from surgery make the problem more noticeable. That is why the tear film and eyelids are examined beforehand, and why a history of red or scratchy eyes is worth mentioning, even if it seems minor.

Can My Post-Surgery Drops Make It Worse?

Antibiotic and steroid drops are needed after surgery, but some contain preservatives (chemicals that keep the bottle free of bacteria) that may irritate a healing surface with prolonged use. Preservative-free lubricants can suit sensitive eyes better, and any change is best made with your surgeon rather than on your own.

Frequent lubricating is not a concern in itself. The type of drop matters more than how often it is used.

Why Is It Worse on Screens or in Air Conditioning?

Screens reduce blinking considerably, and blinking is already reduced after surgery. Air conditioning, heaters and wind dry the tear film further. Some medicines, including certain antihistamines and antidepressants, can lower tear production, and hormonal shifts may also play a part. If you take any medication, do not stop or change it without first speaking with your doctor.

Regular screen breaks and a monitor set slightly below eye level tend to help, and a humidifier may suit dry rooms. These steps support recovery but do not replace a review if symptoms persist.

Does Dry Eye Mean Something Went Wrong?

Mild dryness that slowly eases is what most surgeons hope to see, and it reflects the eye adjusting rather than a complication. Book a review if discomfort is worsening, vision keeps fluctuating, the eye becomes painful or very red, or nothing has improved after several weeks.

Treatment depends on the cause and may range from lubricants and lid care to punctal plugs (tiny inserts that slow tear drainage) or anti-inflammatory drops. Dry eye after laser correction often has more than one contributor, so pinpointing which ones apply to you shapes the plan, and Dr. David Robinson considers most of them manageable with the right approach