As ophthalmologists, we relish the extremely successful outcomes of laser assisted in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), and small incision lenticule extraction (SMILE). However, ensuring the best outcomes for our post-refractive surgery patients involves meticulous education and post-operative care instructions.
This guide aims to provide a thorough overview of both short-term and long-term care strategies, enabling patients to achieve optimal recovery and sustained eye health after they receive laser vision correction. Additionally, included is a sample post-operative care instruction template that can be customized and provided to patients.
7 steps for short-term, post-operative success
The immediate post-operative period is critical for healing and preventing complications. Detailed and clear instructions must be conveyed to patients to ensure adherence and optimal recovery outcomes.1
Immediate post-surgery care
1. Rest and recover.
Instruct patients to rest their eyes and keep them closed immediately post-surgery. The eyes heal much faster this way. Along with the fact that many patients' eyes will still be numb after the procedure, they will not feel their eyes getting dry.
Advise them to avoid activities that require intense focus, such as reading, watching TV, or using digital screens for at least 24 hours. Opening your eyes briefly to use the restroom or to eat can usually be allowed, but only for brief instances.
2. Wear protective eyewear.
Emphasize the importance of wearing the provided eye shield or protective glasses, especially during sleep, to prevent accidental rubbing or pressure on the eyes. Many patients will take a mild sedative like Valium and can forget they have had the procedure when waking up from a nap, the protective eyewear will help avoid any accidental eye rubbing.
3. Avoid water exposure.
Advise patients to avoid exposing their eyes to water. This includes swimming, hot tubs, and even direct showering in the face for at least a week to prevent infection.2
4. Fight the urge to rub.
Clearly explain the risks associated with rubbing or touching the eyes, including dislodging the corneal flap (in LASIK), causing flap striae, or interfering with the healing process.3
5. Do not wear eye make-up.
We want to avoid anything that can cause irritation to the eye and potentially introduce bacteria during the first week of healing. Avoiding makeup is an important step to keep a clean environment for the eye.
6. Use antibiotic and anti-inflammatory drops as prescribed.
Provide explicit instructions on the use of prescribed eye drops. Emphasize the importance of following the dosage instructions strictly to prevent infection and reduce inflammation.4 Providing an eye chart calendar can help patients keep track and maintain compliance as well.
7. Utilize lubricating drops.
Recommend the use of artificial tears to alleviate dryness and discomfort, which are common post-surgery symptoms. Specify the frequency of use to ensure compliance.5
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Refractive Surgery Post-Op Care Instructions
Download this template (and customize as needed for your practice) to give to patients after refractive surgery to optimize post-operative care and surgical outcomes.
Follow-up appointments
Schedule and stress the importance of follow-up appointments. These visits allow for monitoring of the healing process and addressing any concerns promptly. It is imperative to have a visit on post-operative day 1.
You want to look for a meticulous flap without striations, any signs of infection, diffuse lamellar keratitis, and to ensure the patients have good vision.
Activity restrictions after refractive surgery:
- Avoid strenuous activities: Instruct patients to refrain from heavy lifting, strenuous exercise, and activities that could strain the eyes for at least 1 week.
- Limit screen time: Advise limiting screen time and taking frequent breaks to prevent eye strain and dryness. Encourage that if screen time is unavoidable to use frequent lubricating tears during screen time.
Common short-term side effects and remedies
There are several short-term side effects that commonly occur following refractive surgery. By knowing what to expect, that it is likely temporary, and how to manage each, patients are less likely to be panicked or dissatisfied
Three common side effects after refractive surgery are:
- Dry eye: Explain that dry eye is common post-surgery due to reduced tear production. Recommend frequent use of lubricating drops and ensure patients are aware this condition usually improves over time. Studies show the rate of dry eye in post-laser refractive surgery patients can range from 20 to 50%.6
- Temporary glare and light sensitivity: Inform patients that they may experience increased sensitivity to light and glare, particularly at night. Advise wearing sunglasses outdoors especially on bright sunny days.1
- Itchiness: Itching is a common part of the healing process. Reinforce the importance of not rubbing the eyes and suggest using lubricating drops to alleviate discomfort. Itchiness is usually a by-product of dry eyes.1
Serious side effects (near post-op) and treatment
On occasion, more serious side effects can present after surgery. Patients should be made aware of what signs and symptoms constitute an immediate follow-up visit.
Infection
Educate patients on the signs of infection, such as redness, severe pain, or discharge. Stress the importance of adhering to prescribed antibiotic drops and seeking immediate medical attention if symptoms occur.7
Halos/Glare
Explain that some patients may experience halos or glare around lights, particularly at night. This often improves over time, but if persistent, discuss potential treatments or corrective options.8
Macrostriae
Inform patients about the possibility of macrostriae (wrinkles in the corneal flap) and the necessity for prompt treatment, which may involve additional surgical intervention.9 Some patients may have microstriae, which does not affect vision. These can usually be left alone, especially if they are in the periphery of the flap and not in the visual axis.
Diffuse lamellar keratitis (DLK)
Educate patients about DLK, its symptoms (blurred vision, light sensitivity), and the importance of early detection and treatment with steroids to prevent permanent damage.10
Ectasia
Discuss the rare but serious risk of corneal ectasia, where the cornea becomes progressively thinner and bulges outward. Explain the need for regular follow-ups to monitor corneal stability and check corneal topography along with manifest refraction.11
For a deeper dive into how ophthalmologists can manage corneal ectasia following refractive surgery, check out Clinical Pearls for Corneal Ectasia After Refractive Surgery!
Corneal neuralgia
Inform patients about corneal neuralgia, characterized by chronic eye pain, and discuss potential treatment options such as medications, specialized eye drops, or nerve blocks.12
Download the refractive surgery post-op care instructions for patients!
A look at long-term post-operative care
Long-term care education is essential for equipping our patients with the right information to achieve continued eye health. Providing patients with clear, ongoing care instructions will help in achieving these goals.
Educate refractive surgery patients on:
- Getting regular eye exams: Recommend scheduling annual eye exams to monitor eye health and ensure vision stability. Early detection of any issues is crucial for prompt treatment. Especially moderate and high myopes should continue their annual exams to look for any retinal pathology.
- Avoiding eye trauma: Recommend using protective eyewear when engaging in activities that could pose a risk of eye injury, such as sports or home improvement projects.
- Monitoring vision changes: Instruct patients to inform their eye doctor immediately if they experience any changes in vision, discomfort, or symptoms, such as flashes of light or floaters.
Focus on the future: Far post-op conditions and complications
Educate on possible complications that may occur months—or even years—after surgery.
Potential long-term complications of refractive surgery include:
- Myopia progression: There is the potential for myopia progression, so regular eye exams to monitor changes in vision increase in importance.13
- Retinal detachment with myopic patients: Patients with high myopia have an increased risk, compared to the general population, of retinal detachment and should be educated on the symptoms to watch for, such as sudden floaters or flashes of light.14
- Ptosis: Inform patients about the rare possibility of ptosis (drooping eyelid) and the available corrective procedures if it occurs. This usually occurs more as an outcome of the eyelid speculum and less because of the actual laser procedure.
Final thoughts
Refractive surgery can significantly enhance a patient’s quality of life, but proper post-operative care is essential for achieving the best results. By providing detailed short-term and long-term care instructions, ophthalmologists can help ensure a smooth recovery and maintain eye health for years to come.
Staying in close communication with patients and addressing their concerns promptly will further enhance the success of refractive surgery. For a detailed and personalized post-operative care plan, download the provided sample instructions and customize them as needed for your practice.
