Surgery for Chronic Dry Eye: What to Know
If artificial tears and prescription eye drops don't relieve chronic dry eye symptoms, there are several surgical options to consider. Punctal plugs, thermal cautery, and intense pulsed light therapy are minimally invasive surgical options that can help retain moisture in the eyes or improve gland function.
While LASIK surgery can initially cause dry eye, it may improve pre-existing conditions, and temporary measures like punctal plugs can help manage dryness after surgery.
A thorough evaluation by an eye specialist is necessary to determine the most appropriate surgical option based on the underlying cause and severity of dry eye. Before deciding on surgery, discuss expectations and potential risks with your doctor. Post-surgical care and follow-up are essential to monitor the effectiveness of the procedure and manage any complications.
If you've tried several nonsurgical dry eye treatments and still have chronic dry eye symptoms, surgery may be an option.
However, surgery isn't the first treatment recommended for dry eyes. A doctor will likely want to exhaust all other treatment methods before recommending surgical procedures.
Common nonsurgical dry eye disease treatments include:
artificial tears
prescription eye drops that help your eyes produce more tears
warm compresses or other ointments or drops to help treat underlying conditions that may cause dry eyes
Sometimes these treatments aren't enough. If your eyes still feel dry and uncomfortable, a doctor may recommend one of the following dry eye surgeries.
Types of surgery for dry eye
A doctor may recommend one of several dry eye surgical procedures if other treatment options don't work for you. While these procedures are minimally invasive, they may cause side effects.
Punctal plugs
A punctal plug is a barrier in the tear duct that partially or fully blocks your natural tears from draining away from your eyes. This helps keep your eyes moisturized.
There are two types of punctal plugs:
Temporary punctal plugs. These are made from collagen or another material that the body dissolves and absorbs within a few days to months. A doctor may recommend this option so you can test it out or following a surgical procedure like LASIK.
Semi-permanent plugs. These are often made from silicone or acrylic. They can last for years. A doctor can remove them later on if needed.
Both types of plugs are inserted into the puncta, which are small openings where tears naturally drain from your eyes. Semi-permanent plugs are sometimes inserted farther down, in a part of the tear duct known as the canaliculus.
Inserting punctal plugs is a noninvasive procedure. A doctor may or may not provide local anesthesia to numb the area.
You might feel pressure as the devices are inserted. Most people can resume their regular activities immediately.
You may notice an irritated or scratchy feeling near where your doctor inserted the plugs. Most people get used to this feeling.
Other rarer issues can include:
the plug coming out or moving around
an improper fit, which may cause the plug to rub against your eye
increased risk of infection
watery eyes
tear duct irritation
Thermal cautery
Thermal cautery is a minimally invasive surgery where a doctor uses heat to close the tear ducts and prevent moisture loss. It's usually recommended if punctal plugs don't work.
Your doctor may cauterize the opening to your tear ducts permanently. Or the puncta may be cauterized superficially, so they're easy to reopen in the future.
The area will be numbed during the procedure, which typically takes a few minutes.
It's important to avoid touching or rubbing your eyes after the procedure. You will likely be prescribed antibiotics to prevent infection.
Intense pulsed light therapy
Meibomian gland dysfunction (MGD) is a common cause of dry eye disease. People with this condition produce abnormal meibum, an oily substance that prevents tears from evaporating from the eyes.
A 2023 review concluded that intense pulsed light (IPL) therapy may effectively treat dry eyes in people with MGD.
IPL therapy is a noninvasive procedure that's often used to treat skin conditions such as rosacea.
Pulses of light are used to selectively destroy vascular structures in the eyelid. This can help reduce inflammation and improve how the meibomian glands function.
Before you undergo this procedure, a protective gel will be spread around your eyes and you'll be given goggles to wear. A doctor will then use a device to send flashes of light into the skin surrounding your eye.
You'll need to apply a special sunblock to treated areas for 48 hours after IPL therapy. You may need four separate follow-up sessions for the most effective treatment.
Laser surgery
Laser-assisted in situ keratomileusis (LASIK) surgery to correct your vision often causes temporary dry eye. It may also improve preexisting dry eye.
According to the American Refractive Surgery Council, about 60 percent of people in an FDA study who reported dry eye prior to LASIK said they noticed improvements following the procedure.
Because LASIK surgery commonly makes eyes dry while they heal, a doctor may recommend inserting temporary punctal plugs or using other dry eye treatments.
Minor gland salivary autotransplant
Severe dry eye syndrome is sometimes linked to rare disorders, such as Stevens-Johnson syndrome or ocular cicatricial mucous membrane pemphigoid.
Medications and most surgical procedures don't correct dry eye in people with these conditions. This can eventually cause blindness.
If you have severe and otherwise untreatable dry eye, a doctor may recommend minor gland salivary autotransplant. This relatively new procedure involves implanting a salivary gland in place of your tear duct to keep your eyes moisturized.
Consider speaking with a doctor if you'd like to learn more.
Cost
The cost for dry eye surgery varies based on:
where you live
the procedure you undergo
your insurance coverage
A doctor can help you understand more about the cost of the surgery you're considering. If you have health insurance, you can call your provider to discuss whether a procedure is covered and how much you'll have to pay out of pocket.
Dry eyes after surgery
LASIK surgery can often cause ocular side effects, such as dry eye, blurry vision, and light sensitivity.
However, these symptoms are usually mild and temporary. Dry eye almost always improves within a few months, once the eye fully heals.
Cataract surgery may also cause dry eye, but this will usually get better with time.
In the meantime, doctors can recommend other dry eye treatments. These may include punctal plugs or artificial tears.
When to consider surgery
You may want to consider surgery for dry eye if other treatments don't effectively prevent or treat your symptoms.
Talk with a doctor if:
Your symptoms don't improve.
Your symptoms get worse.
Your treatment stops working.
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