Dry eye disease after refractive surgery: comparative outcome of post-laser in situ keratomileusis and Post-photorefractive keratectomy

Background and aim Dry eye disease (DED) is a common complication after refractive surgery, with varying severity between laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) due to differences in corneal nerve disruption. While LASIK involves flap creation, PRK’s surface ablation may offer faster recovery of tear film stability. We aimed to compare dry eye outcomes following LASIK and PRK using objective and subjective metrics. Patients and methods This prospective study included 40 eyes (20 LASIK, 20 PRK) of patients aged 20–40 years with myopia less than or equal to 8D. Exclusion criteria were severe pre-existing DED or corneal thickness less than or equal to 400 μm. Preoperative and postoperative assessments (1 week, 1 month, 3 months) included Ocular Surface Disease Index, Schirmer test, noninvasive tear break-up time, tear height, lipid layer, and meibomian gland function. Results Both groups showed significant DED symptoms at 1 week (Ocular Surface Disease Index: LASIK 42.4±20.34, PRK 40.2±21.80; P >0.05). PRK demonstrated faster recovery, with Schirmer scores normalizing by 1 month (18.5±6.75 vs. LASIK’s 15.65±6.41 mm; P =0.16) and superior noninvasive tear break-up time at 1 month (12.55±6.07 vs. 9.53±6.97 s; P =0.09). Tear height abnormalities were more frequent in LASIK at 1 month (20 vs. 0%; P =0.03). Lipid layer and meibomian gland function remained stable in both groups. Conclusion PRK is associated with quicker recovery of tear film stability and secretion compared with LASIK, suggesting its potential advantage for patients at risk of postrefractive DED.