title: Chronic dry eye symptoms after LASIK: parallels and lessons to be learned from other persistent post-operative pain disorders.
abstract: Laser in-situ keratomileusis (LASIK) is a commonly performed surgical procedure used to correct refractive error. LASIK surgery involves cutting a corneal flap and ablating the stroma underneath, with known damage to corneal nerves. Despite this, the epidemiology of persistent pain and other long-term outcomes after LASIK surgery are not well understood. Available data suggest that approximately 20-55% of patients report persistent eye symptoms (generally regarded as at least 6 months post-operation) after LASIK surgery. While it was initially believed that these symptoms were caused by ocular surface dryness, and referred to as "dry eye," it is now increasingly understood that corneal nerve damage produced by LASIK surgery resembles the pathologic neuroplasticity associated with other forms of persistent post-operative pain. In susceptible patients, these neuropathological changes, including peripheral sensitization, central sensitization, and altered descending modulation, may underlie certain persistent dry eye symptoms after LASIK surgery. This review will focus on the known epidemiology of symptoms after LASIK and discuss mechanisms of persistent post-op pain due to nerve injury that may be relevant to these patients. Potential preventative and treatment options based on approaches used for other forms of persistent post-op pain and their application to LASIK patients are also discussed. Finally, the concept of genetic susceptibility to post-LASIK ocular surface pain is presented.
authors.affiliation: Bascom Palmer Eye Institute, University of Miami, 900 NW 17th Street, Miami, FL, 33136, USA. alevitt@med.miami.edu.
authors.forename: Alexandra E
authors.initials: AE
authors.lastname: Levitt
authors.affiliation: Bascom Palmer Eye Institute, University of Miami, 900 NW 17th Street, Miami, FL, 33136, USA. agalor@med.miami.edu.|Miami Veterans Administration Medical Center, 1201 NW 16th St, Miami, FL, 33125, USA. agalor@med.miami.edu.
authors.forename: Anat
authors.initials: A
authors.lastname: Galor
authors.affiliation: Departments of Ophthalmology, Pathology and Pharmacology, Louisiana State University Health Sciences Center, Louisiana State University Eye Center, New Orleans, LA, USA. jweiss@lsuhsc.edu.
authors.forename: Jayne S
authors.initials: JS
authors.lastname: Weiss
authors.affiliation: Miami Veterans Administration Medical Center, 1201 NW 16th St, Miami, FL, 33125, USA. EFelix@med.miami.edu.|Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA. EFelix@med.miami.edu.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Felix
authors.affiliation: John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA. EMartin1@med.miami.edu.|John T Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA. EMartin1@med.miami.edu.
authors.forename: Eden R
authors.initials: ER
authors.lastname: Martin
authors.affiliation: Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL, USA. dpatin@med.miami.edu.
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Patin
authors.affiliation: Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL, USA. KSarantopoulos@med.miami.edu.
authors.forename: Konstantinos D
authors.initials: KD
authors.lastname: Sarantopoulos
authors.affiliation: Miami Veterans Administration Medical Center, 1201 NW 16th St, Miami, FL, 33125, USA. RLevitt@med.miami.edu.|John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA. RLevitt@med.miami.edu.|John T Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA. RLevitt@med.miami.edu.|Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL, USA. RLevitt@med.miami.edu.
authors.forename: Roy C
authors.initials: RC
authors.lastname: Levitt
mesh_terms: D000818:Animals; D002908:Chronic Disease; D003315:Cornea / Q000601:surgery*; D015352:Dry Eye Syndromes / Q000139:chemically induced*; D006801:Humans; D020731:Keratomileusis, Laser In Situ / Q000009:adverse effects*; D010149:Postoperative Pain / Q000175:diagnosis / Q000517:prevention & control* / Q000628:therapy*; D016896:Treatment Outcome