One of the questions patients on the verge of a laser decision ask me most often in clinic is: “If I have laser, will my eyes become dry?” I hear this especially from people who work at a screen all day and from those who have worn lenses for years; most of them already say “my eyes are dry as it is” and worry that laser will make it worse.
My short answer is this: dry eye after laser is a temporary phase in most eyes, it lasts longer in some, and we can partly see clues before surgery as to who it will last longer in. The risk cannot be eliminated; it is managed. This page was not written to frighten you, nor to say “there is no dryness with this method”. I will report the studies I have, what they measure and where they contradict each other, just as they are.
Short answer: dryness is expected, but usually temporary
Why does laser affect the ocular surface?
Corneal nerves control tear secretion and the blink reflex; the laser procedure affects some of these nerves. According to one review, the main cause of dryness after LASIK is the loss of corneal nerves when the flap is created; as a result, aqueous and oily tear secretion and mucin (the substance that helps tears stick to the ocular surface) decrease.[1] SMILE has been reported to affect the nerves less and to preserve corneal sensitivity better; however, differences in symptoms and tear measurements are not consistent between studies.[2]
“Dry eye” can actually be three different things
- Burning, stinging, a foreign-body feeling: the complaint you feel.
- Blurring that fluctuates during the day: clear in the morning, blurred in the evening or at the screen.
- A surface finding measured at the examination: rapid break-up of the tear film, staining on the surface.
These three do not always go together. One review stresses that no single symptom or finding establishes the diagnosis and that symptoms and findings often do not match each other.[3]
When talking about dryness, it is necessary to separate at the examination which one you mean: feeling, fluctuating vision and measurement are asked about separately. The same word may describe three different situations.
How long does it last? A timeline
The duration varies with the study, the method and what is being measured. Below I give what the studies report as it is; I do not give a single “this many days” figure.
The first days and weeks
In a prospective study following the course of pain in 326 patients who had LASIK and PRK, clinically significant eye pain did not occur at all in 94 patients (28.8%), occurred only on postoperative day 1 in 143 patients (43.9%), and persisted at month 3 or 6 in 59 patients (18.1%).[4] This study measures pain, not dryness; still, it shows that the hardest period is the first day. Symptoms and findings after LASIK have been reported to last about 1 month in general.[1] In a small study of 35 patients divided into two groups by flap hinge position, dry eye defined by a staining criterion was seen at week 1 in 8 of 17 (47.06%) and 9 of 17 (52.94%) in the groups, respectively.[5]
Months 1-3: recovery in most patients
In a randomised study of 34 patients (68 eyes) with LASIK in one eye and PRK in the other, complaints of dryness, visual fluctuation and foreign-body sensation increased at months 1, 3 and 6 compared with before surgery with both methods.[6] In a series of 24 eyes following tear parameters, the measurements (except staining) worsened after surgery and returned to preoperative levels within 3 to 9 months.[7] The review on lenticule extraction also summarises that, after early worsening, recovery generally occurs within 3-6 months.[2]
In the hinge study above, dry eye was found at month 3 in 4 of 16 (25%) and 3 of 17 (17.65%) in the groups, and at month 6 in 2 of 16 (12.50%) and 6 of 17 (35.29%).[5] It is a small study and the course differs between the two groups; that is why I do not tie myself to a single percentage.
Complaints lasting beyond month 6: what do they mean?
In the randomised study, complaints returned to preoperative levels at month 12.[6] In a series of 143 people, chronic dry eye at month 12 was reported in 5.0% after PRK and 0.8% after LASIK; chronicity was more likely in those with a low preoperative Schirmer test (a measure of tear quantity).[8] Among 25,317 patients who had LASIK or PRK, clinically significant dry eye developed in 1,518 eyes (6.0%); the abstract does not state when this rate was measured.[9] Complaints lasting more than a year have been reported in a small group of patients.[1]
Some of the long-lasting complaints are not “dryness” but nerve-related pain. This is described as a low-frequency, little-recognised complication; in 23 patients with chronic neuropathic eye pain, dryness questionnaire (OSDI) scores improved between two examinations a mean of 4.83 years apart.[10] The corneal nerve network, however, remained sparser than in unoperated eyes even at a mean follow-up of 13 years: main nerve density was 9.15 nerves/mm² in LASIK eyes and 11.75 in unoperated eyes. This is a structural finding; symptoms were not measured.[11]
| Period | Expected complaint | What is done |
|---|---|---|
| Day 1 - week 1 | Burning, stinging, pain; most marked on the first day[4] | The prescribed drop schedule is followed. With SMILE Pro you use two different drops for 1 month and the first check-up is the next day; with No-Touch, steroid drops for 3 months, artificial tears for 6 months, first check-up on day 5 (my practice). |
| First month | Symptoms and findings generally last about 1 month[1] | It varies; the surface is checked at the check-up. At the 1-month check-up I look at vision, residual prescription and the ocular surface. |
| Months 1-6 | Recovery continues; 3-9 months depending on the study[2][7] | It varies. |
| Months 6-12 | Return to baseline in the randomised study[6]; chronic dryness in a small proportion[8] | Persistent complaints are measured at the examination. |
| After month 12 | Persistent complaints in a small group of patients[1] | I could not find a robust rate for this period; it varies. |
When should you come back for an examination?
- A sudden drop in vision or blurring
- Pain that increases instead of improving
- Marked sensitivity to light
- Marked redness or discharge
If you have one of these, do not wait for the scheduled check-up; come the same day. This list is a general safety warning. My check-up schedule varies with the method: with SMILE Pro, day 1, week 1, month 1, month 6 and year 1; with No-Touch, day 5 (when the protective lens is removed), month 1, month 3 and month 6 (my practice). At every check-up I look at vision, residual prescription and the ocular surface.
Burning and stinging are common in the first weeks and are usually part of the expected course. What matters is the direction of the complaint: if it is decreasing you are on track; if it is increasing, or one of the signs above is present, do not wait.
Measurement and feeling are not the same thing
What does tear break-up time measure, and what does OSDI measure?
Tear break-up time measures how many seconds after a blink the tear film starts to break up; it is an examination measurement. OSDI is a questionnaire in which the patient scores their own complaints. One looks at the surface of the eye, the other at what you feel.
Comparison between methods: what the literature says, and what it does not
In a meta-analysis of 18 studies comparing SMILE with femtosecond LASIK, tear break-up time was longer in favour of SMILE by 3.267 seconds at month 3 and 3.320 seconds at month 6; OSDI scores were slightly lower with SMILE but the difference was not statistically significant.[12] So there is a difference in the measurement, but no proven difference in the complaint felt. I have also used this finding on my method page: who the SMILE method suits, and its limits.
Another meta-analysis (14 studies) draws a different picture: the reduction in tear break-up time is significant for LASIK (SMD −0.3; confidence interval −0.53 to −0.08), not significant for SMILE (SMD −0.34; confidence interval −0.95 to 0.27), and not significant for PRK either (SMD −0.11; confidence interval −0.29 to 0.08). SMILE's point estimate is not smaller than LASIK's; because the confidence interval is wide, it did not reach significance.[13]
For PRK the data are mixed. In the prospective study, persistent eye pain was more likely with PRK than with LASIK (odds ratio 2.73; confidence interval 1.29-5.77).[4] In a series of 13,319 patients, those who had PRK were more likely to report an increase in dryness at month 3.[14] Chronic dry eye was also against PRK, at 5.0% versus 0.8% with LASIK.[8] Yet in the group of 25,317 patients who developed dry eye after LASIK or PRK, the proportion of LASIK was higher (52.4% versus 38.7%).[9]
These studies do not point in the same direction. One puts SMILE ahead on tear measurement, while the questionnaire does not say the same; in another, the reduction in tear break-up time is significant with LASIK and not with SMILE; for PRK some studies show more complaints and some a different picture. Study designs, patient groups and the way dryness is defined differ.
I cannot promise for any method that there will be no dryness. The choice is made by assessing the ocular surface, corneal thickness and prescription together. For how the prescription behaves after surgery, see also my article Can the prescription come back after laser?; there too I have treated conflicting data between methods in the same way.
If you want to see the methods side by side, look at the comparison.
Compare LASIK, SMILE and PRK (in Turkish) →“A difference in measurement” and “a difference I feel” are separate questions. I do not base the choice of method on a single measurement or a single study.
6 questions you can ask yourself before surgery
1. Are your eyes already dry before surgery?
Burning, stinging, eyes sticking in the morning, end-of-day fatigue: these are the strongest clues. In a follow-up of 24 people who had LASIK, those who went on to chronic dryness at month 9 had lower preoperative Schirmer values.[7] In another series, a low preoperative Schirmer value predicted chronic dryness after both PRK and LASIK, and a high staining score predicted it after LASIK.[8] In the persistent-pain study, preoperative use of lubricant drops (odds ratio 2.41) and a higher eye symptom score (odds ratio 1.11) were associated.[4] On the other hand, in a series of 13,319 patients, those with more complaints before surgery reported more improvement in their postoperative symptom score;[14] so “someone who is dry at the start gets a bad result” should not be read one way only.
What can be done? Reviews consider assessing and correcting the ocular surface before surgery a key step.[3] If it is severe, I first treat the surface and repeat the measurements afterwards. If there is blepharitis (inflammation of the eyelid margin), I first wait for it to heal.
2. Do you wear contact lenses, for how many years, and for how many hours a day?
Among 1,849 laser candidates, 44.9% had a history of lens wear; the dry eye rate was 54.1% in lens wearers and 35.2% in non-wearers (odds ratio 2.17; confidence interval 1.77-2.65).[15] In the series of 13,319 patients, lens wearers also had worse preoperative dryness complaints.[14] However, the data are inconsistent on predicting whether dry eye will develop after surgery: in the series of 25,317 patients, the proportion of soft lens wearers was lower in the group that developed dry eye (40.6% versus 45.5%).[9] Because lenses temporarily change the shape of the cornea, you are asked to stop wearing them before the examination; as a general guideline, at least 1 week for soft lenses and 3 weeks for rigid (gas-permeable) lenses. The periods I apply: I ask you to stop soft lenses 5 days, and rigid (gas-permeable) or toric lenses 2 weeks, before the measurements, and not to put them back in until surgery.
3. How many hours a day do you spend at a screen?
I could not find robust data on this specific to the period after laser. In general, screen use is linked to dry eye, particularly evaporative dry eye, through blinking abnormalities, and pre-existing dry eye is considered a factor that worsens this picture.[16] So your screen time does not decide the laser question on its own, but I always ask about it at the examination.
4. Which medicines do you take?
Antihistamines, beta blockers, antipsychotics, antidepressants and isotretinoin are among the medicines associated with dry eye.[17] This is general information; I do not give a laser-specific risk rate. Do not stop a medicine on your own; tell your doctor about every medicine you take at the examination.
5. Sex, age, hormonal stage and systemic diseases
In the series of 25,317 patients, the group that developed dry eye was older and had a higher proportion of women (48.5% versus 44.8%).[9] In the series of 13,319 patients, the increase in complaints at month 3 was greater in women than in men.[14] Menopause, menstrual cycle changes, use of the contraceptive pill and thyroid eye disease are generally listed among hormonal factors associated with dry eye;[18] I do not give figures for their effect on dryness after laser. Laser is not performed during pregnancy and breastfeeding.
In autoimmune diseases (such as rheumatoid arthritis and lupus), well-controlled patients have been reported as possible laser candidates, while primary Sjögren syndrome is excluded.[19] I could not find a robust source specific to dryness after laser for diabetes.
6. Have you had an ocular surface problem before?
If you have a history of eyelid margin inflammation (blepharitis), meibomian gland dysfunction (insufficiency of the oil glands in the eyelid) or allergy, be sure to say so. I could not find a source giving a rate for how much these conditions increase dryness after laser. In reviews, management of meibomian gland dysfunction is listed among the components of treatment, and optimising the surface before surgery as a key step.[1][3]
At the examination these questions are answered with the following measurements: tear break-up time, surface staining, tear quantity (Schirmer), the OSDI questionnaire and examination of the eyelid margin. Corneal mapping (topography) and thickness measurement are done alongside these. I do not give a sourced threshold value in this article.
My threshold for postponing surgery: if the tear break-up time is below 5 seconds and the Schirmer test below 5 millimetres, I assess that eye separately; this does not mean automatic cancellation of the operation, but treatment first and measurement again. These values are my clinical threshold; I do not present them as a single cut-off valid for everyone.
Where does your ocular surface stand on these criteria? Do a pre-assessment with a few questions.
Start the free suitability assessment (in Turkish) →What is done if you experience dryness?
General approach
The options listed in reviews include tear supplements, anti-inflammatory treatments, eyelid gland care, ointment and covering the eye, tear duct plugs and autologous serum.[1] A systematic review of drug strategies targeting corneal nerve healing and surface balance found 7 randomised trials (n = 484); the authors state that the evidence is limited.[20] Environment and screen habits are also part of this plan. There are options; the choice is the doctor's decision. Which drops to use, how often and for how long, we decide together at the check-up according to the condition of your eye.
Why long-lasting dryness should be taken seriously, but there is no need to panic
Ocular surface pain after laser is treated as a picture separate from dry eye and is linked to abnormal nerve regeneration or nerve sensitivity.[1] It is seen at low frequency, and because it is little recognised it can be identified late.[10] That is why it is important to tell us if your complaint keeps increasing or cannot be controlled with drops. Recognising it is often the first step in managing it.
Why does the picture remain acceptable for most patients who have surgery knowing this risk? Because in studies dryness is mostly seen as a temporary phase: in the randomised study, complaints returned to preoperative levels at month 12,[6] and in the series of 143 people chronic dry eye remained at 5.0% after PRK and 0.8% after LASIK.[8] But this does not mean it will not happen in your eye. That is why we manage the risk by measuring it before surgery and monitoring it afterwards.
Should dryness put you off laser?
When does it make sense to postpone or consider another method?
If there is marked dry eye or active ocular surface disease, it makes sense to treat first and repeat the measurements; reviews also recommend careful patient selection and correcting the surface before surgery.[1][3] If laser is not suitable, there are options that do not touch the corneal tissue (e.g. an implantable lens); because these have their own suitability conditions and their own risks, they are assessed separately: alternatives if laser is not suitable.
The decision is made first with measurement, then together with you. Answering the questions above yourself is a good start; the definitive assessment is made at a face-to-face examination. For more, see the Dr. Güreser's experience (in Turkish) page.
Frequently asked questions
There are differences between studies. One review reports that symptoms and findings after LASIK generally last about 1 month, while the lenticule extraction (mainly SMILE) review reports that recovery generally occurs within 3-6 months. In a randomised study of 34 patients, complaints returned to preoperative levels at month 12. In a small proportion it can last more than 1 year. My check-up schedule varies with the method: with SMILE Pro, day 1, week 1, month 1, month 6 and year 1; with No-Touch, day 5 (when the protective lens is removed), month 1, month 3 and month 6 (my practice). At every check-up I look at vision, residual prescription and the ocular surface.
Not definitely, but a temporary phase of dryness is reported in most studies. In a series of 25,317 patients who had LASIK or PRK, clinically significant dry eye developed in 1,518 eyes (6.0%). A change seen in measurement and the complaint you feel are also not the same thing. The likelihood cannot be eliminated; it is managed with a preoperative assessment.
This is decided by measurement at the examination. If there is marked dryness or active ocular surface disease, the surface is usually treated first; in reviews, assessing and correcting the ocular surface before surgery is considered a key step. Already having dry eye does not automatically mean “you cannot have laser”, but measurement is needed.
The data are inconsistent. Among 1,849 laser candidates, the dry eye rate was 54.1% in lens wearers and 35.2% in non-wearers. By contrast, in the series of 25,317 patients, the proportion of soft lens wearers was lower in the group that developed dry eye after surgery (40.6% versus 45.5%). I will tell you at the examination how long before to stop your lenses.
The literature is not clear. In the meta-analysis of 18 studies comparing SMILE with femtosecond LASIK, tear break-up time at month 3 was 3.267 seconds longer in favour of SMILE, but the difference in the symptom questionnaire (OSDI) was not significant. I cannot promise for any method that there will be no dryness. The choice is determined not by the method but by your ocular surface, corneal thickness and prescription together.
If there is a sudden drop in vision, pain that increases instead of improving, marked sensitivity to light, marked redness or discharge, do not wait for the check-up day; come the same day. Mild burning and stinging are common in the first weeks; still, let us know if it keeps increasing. My check-up schedule varies with the method: with SMILE Pro, day 1, week 1, month 1, month 6 and year 1; with No-Touch, day 5 (when the protective lens is removed), month 1, month 3 and month 6 (my practice). At every check-up I look at vision, residual prescription and the ocular surface.
References
- Toda “Dry Eye After LASIK.” Invest Ophthalmol Vis Sci, 2018. PMID 30481814
- Chen et al. “Keratorefractive Lenticule Extraction (KLEx) Surgeries and Dry Eye: A Narrative Review of Predominantly Small Incision Lenticule Extraction-Based Evidence.” Current Eye Research, 2026. PMID 42847128
- Nair et al. “Refractive surgery and dry eye - An update.” Indian J Ophthalmol, 2023. PMID 37026241
- Kang et al. “Ocular Symptoms After Refractive Surgery.” JAMA Ophthalmology, 2026. PMID 42424051
- De Paiva et al. “The incidence and risk factors for developing dry eye after myopic LASIK.” Am J Ophthalmol, 2006. PMID 16490488
- Murakami et al. “Prospective, randomized comparison of self-reported postoperative dry eye and visual fluctuation in LASIK and photorefractive keratectomy.” Ophthalmology, 2012. PMID 22892151
- Konomi et al. “Preoperative characteristics and a potential mechanism of chronic dry eye after LASIK.” Invest Ophthalmol Vis Sci, 2008. PMID 18172089
- Bower et al. “Chronic dry eye in photorefractive keratectomy and laser in situ keratomileusis: Manifestations, incidence, and predictive factors.” J Cataract Refract Surg, 2015. PMID 26796443
- Shehadeh-Mashor et al. “Risk Factors for Dry Eye After Refractive Surgery.” Cornea, 2019. PMID 31567630
- Valencia-Sandonís et al. “Long-Term Evolution of Chronic Neuropathic Ocular Pain and Dry Eye Following Corneal Refractive Surgery.” Journal of Clinical Medicine, 2025. PMID 40648779
- García-González et al. “Long-term corneal subbasal nerve plexus regeneration after laser in situ keratomileusis.” J Cataract Refract Surg, 2019. PMID 31029474
- Chen KY, Chan HC, Chan CM. “How Effective is Keratorefractive Lenticule Extraction Surgery (KLEx) in Reducing Dry Eye Outcomes Compared to LASIK?: A Systematic Review and Meta-analysis.” Journal of Refractive Surgery, 2025. PMID 40778870
- Sambhi et al. “Dry eye after refractive surgery: a meta-analysis.” Can J Ophthalmol, 2020. PMID 31712000
- Schallhorn et al. “Effect of Gender and Procedure on Patient-Reported Dry Eye Symptoms After Laser Vision Correction.” Journal of Refractive Surgery, 2019. PMID 30855093
- Li et al. “A Multicenter Study of the Prevalence of Dry Eye Disease in Chinese Refractive Surgery Candidates.” Ophthalmic Research, 2021. PMID 32485706
- Mehra et al. “Digital Screen Use and Dry Eye: A Review.” Asia Pac J Ophthalmol (Phila), 2020. PMID 33181547
- Leonardi et al. “Drug-Induced Periocular and Ocular Surface Disorders: An EAACI Position Paper.” Allergy, 2025. PMID 41025570
- Gorimanipalli et al. “Hormones and dry eye disease.” Indian J Ophthalmol, 2023. PMID 37026259
- Chen et al. “Refractive surgery for the patient with autoimmune diseases.” Curr Opin Ophthalmol, 2020. PMID 32412958
- Alamoudi et al. “Neuroprotective and anti-inflammatory strategies for corneal nerve regeneration and ocular surface stability after corneal refractive surgeries: systematic review.” J Cataract Refract Surg, 2026. PMID 41805651
Let us measure where your ocular surface stands.
Your risk of dryness becomes clear by measurement at the examination. You can start with the free suitability assessment.