"The most common reasons why people cannot wear contact lenses are dry eye and atopy," says Eric Donnenfeld, MD in a recent issue of Ocular Surgery News.

Dr. Donnenfeld is a cornea specialist at Ophthalmic Consultants of Long Island (Rockville Centre, NY) and co-chairman of Cornea and External Disease at Manhattan Eye, Ear and Throat Hospital (New York, NY).

To discuss current opinions about the advisability of LASIK for patients with dry eye and atopic disorders, Dr. Donnenfeld challenged a panel of cornea specialists and LASIK surgeons to consider the case of a 47-year-old female patient who desires LASIK. The patient cannot tolerate contact lens wear, has giant papillary conjunctivitis (GPC), a history of asthma, and is using oral antihistamines for allergy symptoms.

In addition to Dr. Donnenfeld, the panel members were:

• Peter A. D'Arienzo, MD (Manhasset Eye Physicians, Manhasset, NY)
• Kenneth R. Kenyon, MD (Eye Health Vision Centers, North Dartmouth, MA)
• Henry D. Perry, MD (also of Ophthalmic Consultants of Long Island)
• Christopher J. Rapuano, MD (Wills Eye Institute, Philadelphia, PA)

Giant papillary conjunctivitis (GPC).

The panel offered these observations, comments and recommendations about this case:

1. Being at or near the age of menopause puts this female patient at greater risk of chronic dry eye problems.


2. Her use of oral antihistamines may be contributing to her dry eye condition.


3. Her history of asthma may put her at risk of atopy, with potential difficulties in corneal healing after LASIK.


4. Studies suggest that patients with ocular allergies have a higher risk of keratitis after LASIK.


5. This patient may do better with new silicone hydrogel contact lenses (a special type of soft lens), which many people with dry eyes can wear successfully.


6. Switching this patient from oral antihistamines to nasal steroids and topical antihistamines may reduce here dry eye problems. Adding flaxseed oil to her diet may also help.


7. Having her use Restasis brand eye drops for several weeks may help her body produce more tears to alleviate dry eye signs and symptoms prior to LASIK surgery.


8. Studies suggest using Restasis for several weeks before surgery can improve LASIK outcomes in patients with dry eyes.

The surgeons also pointed out that dry eye may be the most common reason for visual fluctuation after LASIK surgery, and that treatment of dry eye should be initiated prior to any decision regarding the need for a second surgical procedure.


SOURCE: Evaluating a LASIK candidate who has external disease issues. Ocular Surgery News; Vol 25, No 17, Sept 15, 2007.

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