LASIK Surgery Risks: Complete Guide to Complications & Management

LASIK is among the safest elective surgeries (complication rate <1% for significant issues), but informed consent requires understanding the full risk spectrum.

Common Transient Side Effects (Weeks–Months)

• Dry Eye: 20–50% at 1 month; <5% persistent at 1 year. Managed with preservative-free tears, punctal plugs, cyclosporine, lifitegrast, autologous serum.
• Glare, Halos, Starbursts (Night Vision): Especially with large pupils/high corrections. Usually resolves 3–6 months. Wavefront-guided/optimized profiles reduce incidence.
• Fluctuating Vision: Tear film instability, corneal edema. Stabilizes by 3–6 months.

Refractive Surprises

• Undercorrection / Overcorrection: Residual refractive error. Enhancement (retreatment) possible after 3–6 months if stable, sufficient corneal thickness.
• Regression: Gradual shift toward myopia (common in high myopes, young patients). Enhancement or contact lenses.

Serious / Sight-Threatening Complications (Rare)

Complication	Incidence	Management
Corneal Ectasia (progressive thinning/bulging)	0.04–0.6%	Corneal cross-linking (CXL), ICRS, DALK, PKP. Screening (topography, biomechanics, residual bed thickness) is key prevention.
Infectious Keratitis	0.005–0.02%	Fortified topical antibiotics, culture, possible therapeutic PKP. Strict sterile technique, postoperative antibiotics.
Diffuse Lamellar Keratitis (DLK) (“Sands of Sahara”)	0.1–2%	Topical steroids (intensive), flap irrigation if severe. Early detection critical.
Flap Complications (free cap, buttonhole, dislocation, striae)	<1% (femtosecond laser < microkeratome)	Reposition, suture, transplant. Femtosecond laser drastically reduced rates.
Epithelial Ingrowth	0.1–2%	Observation if peripheral/minimal; lift & scrape if visual axis threatened.
Retinal Detachment	Very rare (<0.01%)	Urgent vitreoretinal surgery. High myopia is independent risk factor.

Risk Mitigation

• Thorough screening (topography, pachymetry, biomechanics, tear film, pupilometry, wavefront).
• Experienced surgeon (>1000 cases) using modern femtosecond laser + excimer platform.
• Realistic expectations: 20/20 not guaranteed; reading glasses after 40; night symptoms possible.
• Adherence to post-op regimen (drops, protection, follow-ups).

For the right candidate, LASIK’s benefit-risk ratio is overwhelmingly favorable. The consultation is where safety is decided.