Chronic Tension in Left Eye Post-LASIK

Hello VSRN,

I had LASIK eye surgery performed on both my eyes over a year ago in April of 2017. Immediately afterwards, I felt I had made a huge mistake. I was left undercorrected in both eyes, but despite this, my visual outcome otherwise seemed okay (some halos and starbursts at night that mostly cleared up over the next few months). My pre-LASIK prescription was -8.50 in each eye. Post-LASIK I am -0.75 in the left eye and -1.00 in the right eye. I did not opt for a second procedure to address the undercorrection.

At the start of June, six weeks after the procedure, I started to develop SEVERE dry eyes. I was waking up in the middle of the night with my eyes glued to the back of my eyelids. I used drops constantly and ointment at night. Over the next two months or so, my symptoms improved quite rapidly and by August I was able to sleep through the night unaided and could get through the day only using drops in the morning when I woke. My eyes were still noticeably dry, particularly on waking, but not so dry that my quality of life was seriously impaired as it was in the beginning. For the remaining summer months, I forgot about these issues and moved on with my life, feeling that I had dodged a bullet and further improvement lay waiting for me.

However, by October/November, my eyes were feeling dry and irritated again, and sleeping unaided was impossible as I was waking up with my eyes glued to my eyelids again. As winter progressed my eyes got dryer. It seemed impossible that my eyes felt otherwise decent enough during the summer but were absolute hell during the winter (I live near Toronto). I struggled through this difficult time, using drops and ointment, and clinging desperately to the notion that my body was healing and things would be better next winter.

As I write this during the summer, the dry eye symptoms are hardly an issue. However, a few months ago and one year post-LASIK, I’m dealing with additional complications with my vision that are wearing on me. I've started developing a chronic tension in my left eye. This tension is usually felt most prominently on the lower right portion of my left eye and inside the eye itself (it’s hard to accurately describe these symptoms). At first it was minor and, while annoying, had little impact on my quality of life. As the weeks progressed, the tension would fluctuate, at times manifesting in a headache and general tension/discomfort in my left eye and the surrounding area (including the brow/forehead). Sometimes this tension would migrate all the way to the back of my neck. This level of tension became more problematic and was definitely impacting my quality of life.

At times, the tension can become so bad that it feels like an enormous pressure or migraine boring into the center of my eyeball. This sensation feels impossible to ignore and I often just want to close my eyes and do nothing when it emerges. It is quite distressing. At its best, the tension is so minimal that it hardly seems worth dealing with. At its worst, it’s all I can think about. The notion of living the rest of my life with my left eye periodically reduced to this level of discomfort doesn’t sit well with me. I also have the faint notion that this is slowly getting worse.

I’ve tried to perform small experiments to better understand and isolate the factors that are contributing to this tension. A few things I’ve noticed:

- upon waking, there is no tension for the first few minutes of the day, then it slowly ‘fades in’

- taking off my glasses causes a small but noticeable worsening of the tension; putting them back on alleviates this

- working on a computer seems to exacerbate the symptoms somewhat, but avoiding computer/screens does not entirely get rid of the symptoms either

- the tension is ALWAYS there in some form, though I might have to consciously focus on the symptoms to recognize their presence because they’re so minimal

- the symptoms fluctuate, as mentioned, but about 90% of the time since these symptoms emerged I would say they have been minimal and not hugely problematic

- occasionally I will have a string of bad days where the tension is noticeably worse; this is when the horrible tension and migraine-like symptoms I described will also emerge

I did visit with my optometrist regarding the tension I was experiencing. She mentioned she also worked at a local LASIK clinic on weekends. She gave some standard boilerplate recommendations and eye exercises to try, but seemed to beat around the bush with regards to how LASIK might have contributed to this situation. It's frustrating, but since discovering this website my predicament makes a lot more sense.

I also have some small visual issues that aren’t hugely problematic but are still annoying. I get some haloing in my right eye when lights are dim. I absolutely hate watching TV or being on a computer screen at night with no other light source. I can drive fine at night time as the halos aren’t huge, but obviously it’s undesirable. Often, I can ‘feel’ the halos as a kind of constant irritation in my right eye, which is often more bothersome than the actual visual symptoms of the halos (this is especially true with computer work). I also notice a loss of contrast sensitivity in my right eye. Reading text while switching between my right eye and left eye really exposes the loss of crispness in my right eye when looking at certain things, especially text. I can still read well enough with my right eye, so in practice it’s more bothersome than problematic.


My left eye has some slight ghosting or smearing downwards, and this seems to have emerged only recently (within the last few months). I’m still trying to understand all of this, but my impression is that the haloing and ghosting in my right and left eye, respectively, are likely caused by the pupil dilating beyond the corneal zone treated by the laser (effectively allowing in light from two different prescriptions). These symptoms are not present during the day or when I shine a lamp toward my face to purposely constrict my pupils. Of course, all these visual symptoms fluctuate day by day and are worsened when my eyes are dry or tired.

I’ve read through several pages of posts on this forum trying to better understand my predicament. Presently, the tension in my left eye is my biggest worry. Based on what I’ve read, I could be experiencing some sort of binocularity issue with my eyes with regards to the tension. I really appreciated Dr. Hartzok’s description in one thread of what an in-depth refraction from a competent eye specialist involves versus an auto-refractor. This shed a lot of insight into the visual system and potential complications with it. My impression is that I should find a knowledgeable and skilled eye care professional who can do a proper and detailed refraction of my eyes in order to isolate any issues. Does this sound about right?

I’m currently in the process of retrieving my medical records from the LASIK clinic that performed this procedure. I should have those within a week or two.

A few questions that come to mind:

Why might this tension emerge only after a year? My prescription has been steady since having had LASIK as far as I know. I never had any problem whatsoever with tension in the first year. Is it anyone’s guess?

Of course – *channeling Forrest Gump* – LASIK is like a box of chocolates….

Could this issue ever resolve itself on its own? Could my eyes adapt? I tend to think that post-LASIK issues rarely improve spontaneously but, if anything, might deteriorate further.

I’ve posted a lot of information here. Some of it is probably superfluous but I wanted to give a detailed account of my experience post-LASIK. I really appreciate anyone taking the time and recommending a prudent course of action to address my issues. I realize post-LASIK care can be expensive, but I was fortunate enough to receive a refund from the clinic I visited and I’m ready and eager to move forward in returning some normalcy to my life.

Thank you for taking the time.


Kyle

Original Post

Kyle,

With your description of symptoms and your age, I would be highly suspect of decompensated binocular vision/accommodative dysfunction secondary to increased spherical aberration and/or any other corneal irregularity that might be present from your surgery.

I have posted some information regarding this type of problem in previous posts on this forum (this problem is actually much more common than is generally recognized) and you can probably find a bit more useful information from those by doing a search here (my name, headache, strain, etc).

Your plan to get a well done refraction from someone skilled in dealing with post refractive surgical problems is a good start, but you might want to find someone experienced with binocular vision as well.  It is challenging to find such an eye care professional as there aren't really all that many experienced with the unique presentations of post-surgical corneas.

Dr. Maller

Dr. Maller,

I've read through some of your prior posts and found them quite illuminating. In particular:

 

"The reality here is that the same aberrations that contribute to the symptoms of glare, halos, spikes, sparkles, loss of contrast, etc., can also contribute to both accommodative dysfunction and throw a "monkey wrench" into the properly functioning binocular vision system. I have seen my share of post-surgical patients complain of this strain, diagnosed "correctly" elsewhere (and possibly by multiple physicians) with binocular vision dysfunction to then pursue various forms of therapy that ultimately all fail to provide relief. Although these therapies are excellent at addressing "normally occurring" binocular dysfunction, the reason they fail in these instances is that none of these therapies are aimed at (or capable of) fixing the underlying reason, which are the aberrations introduced into the visual system by the surgical intervention."

 

I'm still trying to piece all of this together, but from what I gather there could be aberrations on my cornea due to the LASIK procedure that are affecting my quality of vision. My visual system might compensate for these aberrations, lessening their impact, while simultaneously disrupting the equilibrium of the visual system as a whole (and leading to the strain and headaches I described).

One such scenario I'm creating in my mind (and I have no idea how accurate this is) is that the aberrations might introduce blurry and unfocused light into my eye. My pupil constricts, restricting the influx of aberrated light and effectively sharpening the image, but leaving my pupil always in a constricted state. This can introduce further problems into the visual system that I don't fully comprehend at this point, but I do feel I'm getting a better grasp of these things. I appreciate your insights.

Questions --

Speaking hypothetically here, if I were to be fitted with a RGP scleral lens that eliminated all the aberrations on my cornea, would the elimination of the tension follow suit? Of course, this question assumes your suspicions as to what's ailing me are correct. Obviously, each person's circumstances are unique and a thorough examination of my eyes is needed. But the prospect of a single solution that potentially addresses all my issues in one fell swoop is tantalizing. But I'm jumping the gun a little bit here, which leads to my next question.

Is someone from VSRN able to recommend an eye care professional close to me that can perform the in-depth refraction I alluded to in my original post?

Thanks again for your insights Dr. Maller.


Kyle

Kyle,

"I'm still trying to piece all of this together, but from what I gather there could be aberrations on my cornea due to the LASIK procedure that are affecting my quality of vision. My visual system might compensate for these aberrations, lessening their impact, while simultaneously disrupting the equilibrium of the visual system as a whole (and leading to the strain and headaches I described)."

Almost perfect.  It is not that "there could be aberrations..." - there ARE aberrations. If you were myopic prior to surgery, your cornea has been shifted from its naturally occurring prolate shape to a more oblate shape - that was the goal of the surgery. This induces, 100% of the time, an increase in spherical aberration.  This is inherent in the surgical outcome.  The question is, how much of an increase, how it is distributed, and if there are additional increases in other aberrations (coma, trefoil, pentafoil, quadrafoil, astigmatism, tilt, etc.) as well, and whether or not your visual system can adapt and overcome.  All visual systems naturally will expend work/energy to maximize the visual quality despite hindrances that are present, autonomically (without conscious effort), just like digestion/heart rate/respiration/etc. are regulated autonomically.  Whether or not a particular visual system can overcome surgically induced aberrations to provide an acceptable visual performance without causing other symptomology in the process, is dependent on the robustness and reserves of that particular visual system.  This is why there is variability in the presence of your described symptoms of "strain, headache, etc." among post refractive surgical patients.  Said another way, the total amount of your induced aberrations can be small, yet cause a functional problem, but the induced aberrations of another post refractive surgical individual can be considerably greater, yet no functional symptoms are noticed.

"Speaking hypothetically here, if I were to be fitted with a RGP scleral lens that eliminated all the aberrations on my cornea, would the elimination of the tension follow suit?"

"Eliminating all" aberrations in any optical system is really impossible, but "reducing most" of the aberrations present in your optical system is what I have been doing with corneal and scleral gas permeable lenses for more than a quarter of a century.  I have seen the "tension/strain/headache" that had been present for more than a year relieved within as quickly as an hour of getting lenses on.  Some, as long as several weeks, or in some cases, not solely by the lens. Some people will require adjunctive therapies.  It is dependent on the specifics of that individual's situation.

I don't know if you saw this, but this was a video made by John, one of my patients  https://youtu.be/lp-NpbXax8A    John was satisfied with his vision from Lasik, but was debilitated by the headaches. He continues to wear his lenses to this day and functions with no headaches since he started wearing the lenses.  If I recall his circumstances correctly, he reported about 90% improvement in the headaches within 2 days of me fitting him.

I'm sure that Barbara from VSRN can find a doctor recommendation for you near where you are located.

Keep us posted on your progress.  Good luck.

Dr. Maller

 

Dr. Maller,

You response is, once again, very illuminating and encouraging!

The video you linked is most welcome. When I first began researching the issues I'm experiencing, I was very dismayed as it seemed there were dozens of horror stories for every story of recovery. For the first time in quite awhile, I actually feel optimistic and hopeful about my situation.

I'll be sure to update my situation as things progress.

Thanks again!

Kyle

Hey Kyle!

 

I just saw your post and I am sorry you are going through all this! I can totally understand the frustration. I just wanted to say that I have experienced tension and headache similar to yours from time to time after my Lasik too. It wasn't very severe, so it was mostly an annoyance to me and  it was the worst when I was on an airplane. Like you said, those symptoms are difficult to describe so mine may or may not be quite what you are experiencing. Anyway, I thought it wouldn't hurt to mention my experience to you. 

What I found helpful is a use of saline nose spray from time to time. I am guessing my symptoms were caused by sinus pains and there are some articles that I found that suggest that dry eyes can aggravate sinus symptoms. And sinus pains do appear like tension behind the eyes. I am yet to see a second opinion doctor recommended by Barbara (which I am very looking forward to) and I want to ask him about it too among other things. But I found that simple saline spray gets rid of my symptoms even on an airplane. I also live in West Texas, so very dry and dusty year round.

Hope you start feeling better! 

Add Reply

Likes (0)
×
×
×
×