Refractive Surgery (LASIK, PRK, SMILE, ICL): Side Effects, Risks, and What to Expect

Modern refractive surgery is highly successful (>95% achieve 20/20 or better), but side effects and complications exist. Informed consent requires understanding both common temporary effects and rare serious risks.

Common Temporary Side Effects (Days to Months)

• Dry eye: 30–50% at 1 month; usually resolves by 6–12 months. Managed with preservative-free tears, punctal plugs, cyclosporine.
• Visual phenomena: Glare, halos, starbursts—especially at night. Peak at 1–3 months; most diminish by 6–12 months.
• Fluctuating vision: Common during healing; stabilizes by 3–6 months.
• Light sensitivity, foreign body sensation.
• Mild discomfort/pain: PRK > LASIK > SMILE; managed with NSAIDs, bandage contact lens (PRK).

Refractive Surprises

• Under-correction / over-correction: ~1–2%; may need enhancement after 3–6 months if stable.
• Regression: Gradual shift toward original prescription; more common in high myopia, PRK.

Rare but Serious Complications

• Corneal ectasia: Progressive thinning/bulging (keratoconus-like). Risk factors: thin cornea, high correction, abnormal topography. Incidence ~0.04–0.6%.
• Infection (infectious keratitis): ~1/5,000–10,000. Requires urgent antibiotics.
• Diffuse lamellar keratitis (DLK): “Sands of Sahara” — sterile inflammation under flap (LASIK). Treated with steroids.
• Flap complications (LASIK): Dislocation, folds, epithelial ingrowth.
• Epithelial ingrowth / interface haze.
• Retinal detachment: Very rare; higher myopia baseline risk.
• Persistent severe dry eye / neuropathic pain: Rare, debilitating.

Pre-Surgical Screening Reduces Risk

Comprehensive exam: corneal topography/tomography, pachymetry, tear film analysis, pupilometry, retinal exam. Contraindications: keratoconus, unstable refraction, severe dry eye, autoimmune disease, pregnancy.

Decision Framework

Discuss your specific risk profile, visual needs, and lifestyle with your surgeon. Most patients are highly satisfied; serious complications are rare but life-altering.