A 40 year old male went for a LASIK consultation and was told that he would be a great candidate for the procedure. He had complained prior to surgery that he had very dry eyes and often woke up with painful eyes, but the surgeon told him that he would still do well with the procedure.

During the course of the surgery the flap kept folding over and sticking to itself resulting in multiple wrinkles called striae. When the surgery was over the outer most layer of the cornea appeared to be dry resulting in a mild corneal abrasion. Therefore a bandage contact lens was place on that eye as a protective measure. The patient called the office early the next day complaining of EXTREME pain and light sensitivity and was instructed to come right in. Upon evaluation it was determined that there was a large abrasion resulting in the edge of the flap lifting up. There were also multiple striae in the flap which caused substantial visual decrease.
Since the abrasion was present it was decided to leave the lens on for another 24 hours and to reevaluate the eye the next day. On the next follow up, there were more striae present and the vision was now down to 20/200. To improve the refractive surface and improve the vision, the corneal flap was "re floated" to flatten it out and eliminate the striae. This was accomplished, but during this procedure the entire outer layer of the cornea pealed off. Aside from being extremely painful this further reduced the vision. While the flap was now smooth, it lost the epithelial layer. Another bandage contact lens had to be reapplied until the epithelium grew back.

Two days later the patient returned, still in pain, still blurry. The epithelial layer had regenerated and was beginning to cover the cornea again. Unfortunately, it was also growing under the cornea which required going back into surgery to once again lift the flap to clean out these cells. Once again, the outer layer came off and needed another contact lens. Finally after 10 more days, the epithelium regrew and the pain was eliminated. However, the central cornea was now hazy and the vision was still 20/200. Pred Forte steroid eye drops were prescribed to treat this new problem.

This individual also suffered from severe allergies and constantly had the need to rub his eyes. After fighting the feeling for several weeks, in his sleep he gave in and rubbed his eye ...vigorously. Feeling substantial pain he woke up to notice that he could not see out of that eye. Early the next morning he once again returned to the office with a red, painful, blurry eye. An examination disclosed that the cornea flap had been torn off the eye and was no where to be found. With out the flap, there was no hope of helping this cornea and an emergency corneal transplant had to be performed. This was accomplished and many months later the patient had his vision restored with a noticeable degree of astigmatism. He was fit with a custom designed contact lens which restored his vision to 20/30.

While this case scenario is quite unusual and fortunately is a rare occurrence, any one considering refractive surgery must consider that it may occur to them. It may not be as a result of the surgeon or the follow up care, but simply a series of bad side effects that could happen to anyone. In short, all candidates must be aware of all the potential complications and be willing to accept them if they occur.