I am sorry for the length of this post but I am desperate to get help from people who have experience with this topic.

On March 12, 2009 I had Intralase with Wavefront. My correction was not very bad
–2.75 in both eyes with an astigmatism in my left eye. Minutes before the procedure the doctor gave me a prescription for Restasis and put plugs in my lower lids, I was really taken back. I asked him why I need plugs and a prescription? He told me that I was at risk for dry eye and that they wanted to take preventative measures. This was my second visit to the doctor BUT the first time I had ever even heard that I was “at risk” for dry eye! The whole thing rattled me a little because I had read the horror stories about dry eye. I spoke with the lasik surgeon about it and he said “I have never heard of anyone with permanent dry eye, you may experience a little dry eye but it wont last long”!! Obviously, I know better NOW after the surgery!


Since the surgery life has been horrible! My quality of life has diminished so much that I am almost none functional. As a teenager I struggled with depression and anxiety but I have be in good mental for a number of years....until now. My guilt and decreased quality of life has sent me in to a massive depression. The fear that I will never be without these symptoms has caused me such great anxiety. I have actually started to see a therapist and I have started taking antidepressants and anti-anxiety drugs. I feel like I am going crazy, the doctors can’t figure out what is wrong and they just keep telling me that I should be happy because I have 20/15 vision!

Here is the story:
Immediately following the procedure I had noticeably more pain in my left eye compared to my right eye. About 1 week following the surgery I went in to speak with the doctor (not the lasik doctor but the optometrist). I told him that my left eye was in horrible pain and extremely irritated (excessive foreign body sensation). At the time I was still using the prednisolone and antibiotic along with the Restasis and refresh drops. He told me that I had dry eye along with extreme allergic irritation. He told me to stop everything except for the refresh drops and the Restasis because it appeared that I was having any allergy to something. He told me to start using Pataday in addition to the Restasis and artificial tears.

The irritation resolved for a few days but quickly came back....then my symptoms began to get worse. In addition to the burning/irritation I began to feel pain and pressure behind my left eye and get intense sinus-like headaches above my eyes (brow line). The pain and pressure can be sharp or a dull ache. The pain is the strongest at the junction between my eyelid and my eyebrow but radiates around my entire eye. My right eye occasionally gets the pain and pressure but it is mostly localized to my left eye. I went back to the optometrist, he told me that aside from the “allergy” that he could not find anything wrong. I got angry and made an appointment with the actual surgeon.

The surgeon said I had severe blepharitis, which could be causing my problems. He gave me a new steroid drop to use 4X a day and erythromycin ointment for my lashes. It has been 2 weeks since I saw the surgeon. I feel like my symptoms are actually getting worse. I have had a headache everyday for 3 weeks. I find myself straining and squinting to watch TV or look at the computer. I have a constant sinus-like pressure over my eyebrows and eyes are painful and extremely irritated (especially my left eye which is about 100 times worse than my right eye).

I am a graduate student trying to write my thesis, imagine how difficult that is when you have a headache and a raw eye. I will be starting vet school in August, I got this surgery so my life would be easier while I was working on my doctorate but instead my life is horrendous.

I know I am not crazy and that there has to be a better explanation than “blepharitis” and “allergic conjunctivitis”! I can’t imagine that those two things would cause headaches and intense eye pressure. Additionally, the doctors say that I have no refraction so accommodation pain is not the cause of my headaches and eye strain. Based on that stupid eye chart they say I am seeing 20/15 but I disagree. I have a hard time focusing and feel just plain “off”. Almost dizzy.

I really need some advice, I simply don’t know where to turn. I would like to see someone who specializes in lasik complications but I don’t know where to find a doctor like that in my area. Any suggestions would be appreciated.

I should add that I have been taking Omega 3’s and using the Tranquileyes moisture chamber goggles at night. I also use lids scrubs.

Sorry to hear about your problem. Preventive dry eye care is a common part of the LASIK procedure. (Of course, Restasis in these cases is off-label. It takes several weeks to even begin working and it is prescribed for ocular inflammation secondary corneal/conjunctival dryness.)

First of all, the feeling of dryness associated with LASIK can be disproportionate to the actual physical findings. LASIK "dry eye" is considered to be neurological in part due to the severing and ablation of the corneal nerves. I personally think the covering of the severed nerve endings with the corneal flap is a contributing factor. Fortunately, many of the nerves will find their way to regenerate back through the flap and restore some corneal sensitivity and, with that, your symptoms of dryness will subside somewhat. So, (1) you can expect some of this to abate over the next several months.

Your post states: "I have had a headache everyday for 3 weeks. I find myself straining and squinting to watch TV or look at the computer."

THIS bothers me. I think you need a second opinion to check for residual refractive error and accommodative strain. Even a 20/15 acuity can still have spherical aberrations that causes eyestrain. I have found that surgical centers are not always adept at determining these things and, therefore, don't render the best opinions.

Your post further states your have "constant sinus-like pressure over my eyebrows and eyes are painful and extremely irritated (especially my left eye which is about 100 times worse than my right eye)."

While a residual refractive error might cause the first noted visual symptoms, a constant pain above the eyes seems unlikely to be associated with refractive error or accommodative strain. Do you get any relief with the eyes closed? Does the pain subside with a topical anesthetic? You are right. Blepharitis and allergic conjunctivitis do not create these types of symptoms. Again, another opinion is indicated to check the cornea for any irregular wetting or surface defects.

Thanks Dr. Hartzok.

I asked my doctor about accommodative strain at my last visit and he assured me that I had no residual refractive error! I would like to get a second opinion but do not know where to go?

As far as getting relief from the brow pain, closing my eyes or taking meds does not help. I use hot compresses but I haven’t seen much beneficial result from them either. At my last appointment the doctor mentioned that I had a spot on my left eye that was not wetting, he referred to it as dry spot or something to that affect. He mentioned “scratching it” to initiate healing…actually inflicting an abrasion!!! What do you make of that?

If there is an area of non-wetting on your cornea that is recurrently eroding, then his recommendation would not be illogical. However, in normal cases of recurrent erosion, a bandage contact lens can provide relief or at least be a prognosticator for whether such a procedure is indicated. Your pre-LASIK prescription was not very strong, which means a standard soft lens might be an acceptable bandage. If a trial with a soft lens does nothing to relieve the pain, then the pain is not secondary to the non-wetting area on your cornea and your doctor will have to look elsewhere for the cause.

UPDATE:

I went to a neuropthamologist at the University of Houston. After 6 hours of extensive testing including EEG, retinal mapping, ultrasound and tons of other things....the doctor said I had severe Trochleitis (inflammation of the superior oblique tendons around my eyes). My tendons were inflamed to 10.5mm which is about 4.5mm larger than normal. She put me on some oral NSAIDs but said I would probably need an injection. All she had to do was push on the upper corner of my eye and it immediately triggered the pain. The doctor said she had seen this a lot after the trauma of lasik.

Additionally, she told me to stop all the drops I was using and it really helped the itching and irritation, basically the drops were doing more harm than good. I am glad that I have some explanation for the pain but I still have this weird anxiety about my sight, I honestly feel like I just don’t see right. She told me that I had issues with convergence and gave me exercises to work on that. I don’t know if it is the convergence issue or what but I have felt so out of it since the initial procedure, sort-of lightheaded and not processing the same. All I can do is pray that things will eventually go back to normal.

Congratulations on finding a solution to the pain portion of your complaint. Hopefully the NSAIDs will relieve the inflammation. Be patient for a few weeks until the trochleitis is controlled. I would lay off the eye muscle exercises for now since that may further aggravate the trochleitis.

Any abnormality in extra-ocular muscle function can leave you feeling visually "out of it" even in the absence of detectable imbalances. Binocularity requires "ultra-fine" muscle control: It doesn't take much to throw things out of kilter.