What Are The Contraindications For Lasik Eye Surgery

Age-Related Factors

Under 18: Eyes Still Developing

LASIK requires that the eye has finished its natural growth and refractive development. For most patients this happens in their late teens, which is why the minimum age threshold is 18 years. Operating before stabilisation is complete risks correcting a moving target—the prescription continues shifting post-surgery, delivering an outcome that was obsolete the moment it was made. Our guide on the best age for LASIK explains the developmental reasoning and what age-related milestones surgeons actually look for.

Over 40: Presbyopia Enters the Picture

LASIK corrects corneal refractive errors—myopia, hypermetropia, astigmatism—but it does not address presbyopia, the age-related stiffening of the crystalline lens that causes difficulty with near focus. Patients over 40 who are primarily troubled by reading difficulty may find that LASIK delivers excellent distance vision but still requires reading glasses. This isn’t a failure of the procedure; it’s a limitation that needs to be clearly understood upfront. Our article on correcting presbyopia after LASIK covers what options exist if this becomes a concern post-operatively.

Unstable or Fluctuating Prescription

LASIK produces lasting results when it corrects a stable, established prescription. If your spectacle power has changed by more than 0.5 dioptres in the past 12–24 months, your eyes are still shifting—and LASIK on a drifting prescription typically leads to either under-correction or a need for re-treatment within a few years. The most common causes of prescription instability include hormonal fluctuations, corticosteroid use, and ongoing unmanaged eye conditions. This is also why patients with prescriptions at the outer limits of the treatable range require particularly careful assessment before proceeding.

Corneal Thickness and Shape

Thin Corneas and Ectasia Risk

LASIK removes corneal tissue to reshape the optical surface. If the cornea is too thin to begin with, insufficient tissue remains after the procedure to maintain structural integrity—and the cornea can begin to bulge forward under normal intraocular pressure. This condition, called post-LASIK ectasia, is among the most serious complications associated with the procedure and is the primary reason corneal thickness assessment is mandatory before surgery.

Keratoconus and Irregular Corneas

Keratoconus—a progressive condition where the cornea thins and takes on a cone-like shape—is a firm contraindication for LASIK. The procedure would accelerate the structural weakening already underway, with potentially severe visual consequences. Even subclinical or suspected keratoconus, which may not yet cause noticeable symptoms, is sufficient reason to decline the procedure. Patients with keratoconus are typically candidates for corneal cross-linking (C3R) to arrest progression.

Current or Prior Eye Conditions

Dry Eye Syndrome

LASIK temporarily disrupts the corneal nerves that govern tear secretion, which is why mild dryness is a near-universal post-operative experience. In patients with pre-existing dry eye syndrome, this disruption is amplified—sometimes severely—leading to chronic discomfort, fluctuating vision, and impaired healing. Moderate to severe dry eye is typically a contraindication until the condition is adequately managed. Our article on LASIK in the context of keratoconjunctivitis sicca addresses this specific diagnostic category directly.

Glaucoma

The corneal reshaping performed during LASIK alters the physical properties of the cornea in ways that affect intraocular pressure (IOP) readings. Since IOP measurement is the primary tool for managing glaucoma, LASIK makes it significantly harder to monitor the condition accurately after surgery. For patients with advanced or poorly controlled glaucoma, this interference is clinically unacceptable.

Retinal Disorders

Conditions including retinal detachment, diabetic retinopathy, and retinal holes all represent contraindications—either absolute or relative depending on severity. LASIK addresses the cornea, not the retina, so it cannot help these patients visually, and the procedure itself carries added risk in eyes with compromised retinal health. If you have been told you have retinal pathology, our article on whether LASIK is possible with retinal holes explains how individual assessment works in these cases.

Active Infections and Cataracts

Any active ocular infection—bacterial, viral, or fungal—must be fully resolved before LASIK is considered. Operating on an infected eye dramatically increases the risk of spreading the infection into the surgical site. Similarly, cataracts that are already impairing vision are better addressed through cataract surgery, which can incorporate refractive correction simultaneously, rather than adding LASIK on top of an already compromised lens.

Systemic and Autoimmune Diseases

Uncontrolled Diabetes

Poorly controlled diabetes impairs wound healing across all tissues—the cornea is no exception. Fluctuating blood glucose also causes fluctuating lens refraction, making it difficult to establish a stable pre-operative prescription. Well-controlled diabetics may still be candidates, assessed individually.

Autoimmune Conditions: Lupus, Rheumatoid Arthritis, Hashimoto’s

Autoimmune diseases create unpredictable healing environments. Corneal wounds that would resolve cleanly in a healthy immune system may heal slowly, irregularly, or with scarring in patients whose immune response is dysregulated. Patients taking immunosuppressive medications face compounded infection risk. This applies to a wide range of autoimmune diagnoses. Our articles on LASIK for lupus patients and LASIK with Hashimoto’s disease go into the condition-specific nuances that determine whether a patient can safely proceed.

Pregnancy and Breastfeeding

Hormonal changes during pregnancy and lactation cause temporary fluctuations in corneal curvature and refractive error—meaning the prescription measured during these periods may not represent the eye’s stable baseline. Additionally, several medications standard in the LASIK post-operative protocol (antibiotics, anti-inflammatories) carry restrictions during pregnancy and breastfeeding. Most surgeons advise waiting at least three to six months after weaning before undergoing LASIK, once prescription stability is confirmed.

Lifestyle and Occupational Factors

Certain professions and activities introduce a contraindication that is less clinical and more situational. Professional athletes in high-impact or contact sports—boxing, martial arts, rugby—face an elevated risk of post-operative flap trauma that makes flapless procedures a better fit. Military personnel and some government service roles are subject to institutional guidelines about LASIK that vary by organisation and should be confirmed with the relevant authority before proceeding.

Psychological readiness is also a genuine consideration. LASIK requires a cooperative patient during a procedure that, though brief, involves lying still with the eye held open by a speculum. Patients with severe procedural anxiety or certain untreated mental health conditions that affect compliance with post-operative care may require additional preparation before the procedure is appropriate.

Other Considerations

Patients who have already had a refractive procedure—whether a prior LASIK, PRK, or other corneal surgery—may still be candidates for enhancement, but only if residual corneal thickness is adequate and the overall ocular profile supports it. This requires an individual assessment rather than a blanket answer. Our guide on having LASIK more than once explains the eligibility criteria and what surgeons look for in repeat-procedure candidates.

If You Don’t Qualify: What Are the Alternatives?

A LASIK contraindication is not the end of the road for vision correction—it is a redirect toward the procedure that is actually appropriate for your eyes. The most commonly recommended alternatives include:

• Trans-PRK / Surface Ablation — suitable for patients with thinner corneas who are not keratoconus-positive; no flap is created, reducing structural risk.
• EVO-ICL — an implantable collamer lens placed inside the eye without removing corneal tissue; well-suited for patients with thin corneas or very high prescriptions.
• Refractive Lens Exchange (RLE) — replacing the natural lens with a premium intraocular lens; particularly relevant for patients over 45 where presbyopia is a significant component.
• C3R (Corneal Cross-Linking) — for keratoconus patients, C3R arrests progression rather than correcting the refractive error, but it is often the safest first intervention before any vision correction is considered.