PRK Vs Smile Dry Eyes

Considering laser vision correction but concerned about dry eyes? Dry eye syndrome is a prevalent concern for patients exploring PRK and SMILE procedures.

This comprehensive guide delves into the impact of each procedure on dry eyes, equipping you with valuable information to make an informed decision.


Understanding Dry Eye

Dry eyes occur when the tear film, a vital component responsible for lubricating and protecting your eyes, is disrupted. This disruption can stem from decreased tear production or increased evaporation.

  • Causes of Dry Eye:
    Decreased Tear Production: This can be caused by underlying medical conditions like Sjogren’s syndrome, certain medications (antihistamines, antidepressants), hormonal fluctuations (menopause), and ageing.
  • Increased Tear Evaporation:
    This often occurs due to dysfunction of the meibomian glands located in the eyelids. These glands produce the oily layer of the tear film, which is crucial for preventing tear evaporation. Factors like environmental conditions (dry air, wind), contact lens wear, and blepharitis (inflammation of the eyelids) can contribute to this dysfunction.
  • The Tear Film Trilogy:
    To truly appreciate the impact of PRK and SMILE on dry eyes, it’s crucial to understand the anatomy of your eye’s tear film.
    The tear film comprises a sophisticated three-layered structure that must maintain equilibrium to ensure stability:
  • Oily Layer (Lipid Layer)
    Produced by the meibomian glands, this layer forms a seal on the tear film, preventing evaporation.
  • Mucin Layer (Mucous Layer)
    Produced by goblet cells in the conjunctiva, this layer helps the aqueous layer spread evenly over the cornea.
  • Aqueous Layer (Watery Layer)
    Produced by the lacrimal glands, this layer is the main component of tears, providing lubrication and nourishment to the cornea and washing away debris. When one of these layers falters, dry eye symptoms may arise.


Impact of Laser Vision Correction on Dry Eyes

All laser vision correction procedures, including PRK and SMILE, can potentially impact tear film stability and contribute to dry eye symptoms. This is because they involve reshaping the cornea, which can disrupt the delicate balance of the tear film. However, the extent of this impact varies depending on the specific procedure.


PRK (Photorefractive Keratectomy)


  • Suitable for thin or irregular corneas:
    An excellent choice for individuals with thin or irregular corneas who are not suitable candidates for LASIK due to the risk of flap complications.
  • Reduced risk of flap-related complications:
    Since no corneal flap is created, there’s no risk of flap displacement or infection, potentially beneficial for individuals in high-risk professions (e.g., athletes and firefighters).


  • Longer healing time:
    PRK takes longer to heal compared to SMILE, leading to potential dry eye discomfort lasting for a week or more.
  • Increased initial discomfort:
    The healing process can involve temporary symptoms like stinging, light sensitivity, and blurry vision due to the disruption of the corneal epithelium.
  • May exacerbate pre-existing dry eye:
    PRK, being a surface ablation procedure, can worsen pre-existing dry eye as it disrupts the corneal epithelium, potentially worsening tear production.


SMILE (Small Incision Lenticule Extraction)


  • Faster healing time:
    The flapless SMILE boasts a faster healing time compared to PRK, minimising dry eye discomfort and vision recovery time.
  • Minimally invasive:
    Small incision and minimal tissue disruption result in less disturbance to corneal nerves, minimal impact on the anterior corneal nerve, more intact outer corneal layer, superior biostability, potentially reducing dry eye symptoms.
  • Promising for dry eye patients:
    Studies suggest SMILE may be a better option for individuals with pre-existing dry eye compared to LASIK and PRK due to less disruption of corneal nerves involved in tear production.


  • Limited availability:
    SMILE is a newer technology and may not be available in all clinics compared to LASIK and PRK.
  • Less established long-term data:
    While initial studies show promising results, long-term data regarding SMILE’s efficacy and potential long-term impact on dry eye is still accumulating.


Additional Considerations

  • Age:
    Dry eye symptoms are more common among older individuals, increasing the likelihood of post-operative dry eye in this demographic.
  • Medications:
    Specific medications can worsen dry eye. It’s vital to disclose all medications to your ophthalmologist prior to laser vision correction.
  • Environmental factors:
    Factors like dry air, wind, and excessive screen time can worsen dry eye symptoms. It’s crucial to be aware of these influences and implement strategies to address them when undergoing laser vision correction.


Which is Better?

While both PRK and SMILE offer benefits for correcting vision, SMILE appears to be a more favourable option for individuals with pre-existing dry eye due to its:

  • Minimally invasive nature:
    The small incision and minimal tissue disruption in SMILE lead to less disruption of corneal nerves compared to PRK. These nerves play a crucial role in tear production and sensation, and less disruption can potentially minimise post-operative dry eye symptoms.
  • Faster healing time:
    Compared to PRK, SMILE boasts a faster healing process, which translates to a shorter duration of potential dry eye discomfort. This quicker recovery time can be particularly beneficial for individuals already experiencing dry eye symptoms.
  • Emerging evidence:
    While further research is ongoing, studies suggest SMILE may have a less significant impact on dry eye symptoms compared to LASIK and PRK. This potentially translates to a lower likelihood of worsening pre-existing dry eye after the procedure.
  • Individual factors are key:
    Each person’s eyes and response to surgery are unique. While SMILE might generally suit dry eyes better, consulting a skilled ophthalmologist who can evaluate your specific situation and medical history and conduct a thorough dry-eye assessment is crucial.
  • Effective dry eye management:
    Regardless of the procedure chosen, managing pre-existing dry eye consistently before and after surgery is vital. This may include using artificial tears, practising eyelid hygiene, and addressing any underlying medical conditions contributing to dry eye.
  • Empowering Your Vision Journey:
    Deciding between PRK and SMILE is deeply personal and requires thorough understanding and guidance. The complexity of dry eye syndrome adds a layer of significance to your choice, potentially steering you towards a procedure that is better catered to your specific eye health needs.

Laser vision correction is not a one-size-fits-all solution, and individual variances in dry eye presentation and lifestyle must be factored into the equation. Remember to engage in open discussions with your eye care provider, ask questions, and weigh the benefits against the potential impacts on dry eyes for a vision correction experience that aligns with your wellness goals.
Seeking input from a trusted eye care specialist is non-negotiable. Take the time to invest in this crucial step of your vision correction process.


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