Ocular surface disease following LASIK and cataract surgery: a review of their interrelated complications

Ocular surface disease is a multifactorial condition that is very commonly caused by dry eye disease (DED). Ophthalmic procedures intended to improve visual outcomes, laser-assisted in situ keratomileusis (LASIK) and cataract surgery, can paradoxically cause or exacerbate underlying ocular surface disease. This results in worsening vision and quality of life.

This review examines the pathophysiological mechanisms contributing to ocular surface disease development following LASIK and cataract surgery. Both procedures are associated with the transection of corneal nerves, leading to decreased tear production, surface instability, altered neurotrophin production, and impairment of the blink reflex. Furthermore, these incisional procedures stress ocular tissues, while the use of preservatives in topical medications administered during or after these procedures may exacerbate dry eye symptoms. Management strategies for postoperative dry eye disease include, but are not limited to, the use of artificial tears, anti-inflammatory agents such as cyclosporine A or lifitegrast, nerve growth factor therapies, and procedural interventions including punctal plugs, thermal pulsation, lid exfoliation, and intense pulsed light therapy. Additionally, artificial intelligence has emerged as a promising tool to enhance the selection of optimal candidates, thereby minimizing risk and optimizing postoperative outcomes and improving patient satisfaction.

LASIK and cataract surgery are highly effective vision correction procedures that have constantly evolved to improve visual outcomes and mitigate side effects. However, ocular surface diseases remain a common complication affecting the outcome and quality of life of post-operative patients. The integration of personalized treatment and AI-based screening protocols can help improve patient outcomes.