A Far From Trivial Procedure
Despite being so commonplace that it’s now advertised on television in between daytime soap operas, laser eye procedures such as LASIK and LASEK are still surgical operations. This means that they involve invasive procedures and, as with other surgeries, the recovery can be somewhat painful.
As the procedures have become trivialised throughout the UK, along with cosmetic operations like tummy tucks and breast enhancements, there is a common misconception that the surgeries are both risk and pain free. Sadly this isn’t the case and those planning to have laser eye surgery need to be prepared to experience some discomfort while the wound heals. There is also a small yet very real possibility of pain stemming from complications and side effects of the operation. While complications are rare, they can, and do, occur.
Does The Procedure Itself Hurt?
In most cases, laser eye surgery is performed under a local anaesthetic, often administered in the form of eye drops. Although the patient will be awake during the procedure, the anaesthetic should mean that the eye and surrounding area is numbed, so no pain can be felt. However, patients may feel a slight pulling or tugging sensation around the eye as the surgeon works, but this should be mere discomfort as opposed to actual pain. The discomfort may be heightened for those patients who are particularly sensitive about having objects and items close to their eyes.
Patients who are intolerant to local anaesthetics or who are particularly anxious about the operation, may be offered a general anaesthetic instead. Patients who undergo a general anaesthetic will not be awake for the procedure and in most cases will experience no pain nor any awareness during the operation. The disadvantage with general anaesthetics however, is that they are slightly more risky than the topical alternative, and recovery times may be greater, leading to an in-patient stay. When performed under local anaesthetic, the surgery is typically undertaken on a day patient basis.
Does Post Operative Pain Vary By Surgery?
There are many different types of laser eye surgery currently available in the UK, each using a different method, technique or equipment to correct vision, usually by creating a small incision in the lens and breaking down or reshaping the cornea to improve sight. Due to the different techniques, it is widely accepted that levels of post operative pain differ rather significantly depending upon what type of surgery is being performed.
Generally speaking, patients undergoing the newer, more LASIK surgery are less likely to experience post operative pain than patients having laser eye surgery in the form of the older PRK method. In fact, whereas an estimated 81% of LASIK patients report no pain whatsoever 24 hours after the surgery, almost every patient who has had PRK surgery will still be in some degree of pain at the same interval. It is possible that this is due to LASIK being a far less invasive procedure, whereby the corneal covering remains attached throughout the operation, unlike PRK where the front of the cornea is removed entirely before being replaced.
PRK patients often report the onset of pain around one hour after the operation, at a time when the local anaesthetic will be beginning to wear off. As the anaesthetic wears off completely, the pain is likely to hit its peak at around 4 to 6 hours post-op, remaining at this level for anywhere between 36 and 48 hours. After this time, the pain should start to subside, although there may be some continued discomfort in the eye area until the corneal wound has healed entirely. Patients who are still in significant pain after 48 hours should get themselves checked out by their GP, local hospital or eye clinic to rule out infection or surgical complications.
Complications and side effects from the surgery may be the cause of some post operative pain. While severe complications are rare, dry eye syndrome is very common, and occurs because the cornea experiences decreased sensation during the healing process, which means it has difficulty in stimulating the tear ducts. Dry eyes can cause pain, especially when blinking, and can feel like having grit or sand in the eye. Fortunately, the condition is temporary and is easily treatable.
Research shows that any pain a patient experiences during laser eye surgery on one eye is likely to be similar to that experienced if the surgery is carried out on the other eye at a later date. This means that a patient who is fortunate enough to experience very little pain and discomfort is likely to be just as fortunate the second time around, whereas those who have a bit of a rough time could be in for some more discomfort, so it’s good to be prepared.
Can Anything Be Done To Reduce Pain?
There is no need for patients to suffer in silence, as there are many different analgesics and other products that can help reduce the amount of pain felt after laser eye surgery, bringing it down to a bearable level, or getting rid of it altogether. It’s a good idea to keep some over the counter painkillers such as Paracetamol handy, but your doctor may be able to prescribe something stronger for those who need it.
The best types of analgesics for laser eye surgery are topical anti-inflammatories that don’t contain steroids or anaesthetics. While these are beneficial in minimising pain, steroids could cause glaucoma, and anaesthetic products could delay the healing of the cornea. However, doctors may prescribe these medicines for patients whose pain is causing disturbed sleep and is interfering with everyday life.
In most cases, it’s best to look at non-steroid, non-anaesthetic anti-inflammatories such as Diclofenac, Flurbiprofen, Indomethacin, or Ketorolac. These medicines have been found to reduce burning and stinging in PRK patients, and have demonstrated a 32% reduction in pain at a 4 hour post operative interval for LASIK patients. Taking these anti-inflammatories prior to surgery has also proven to be beneficial, although patients should always check with their surgeon before taking any new medications prior to surgery.
Patients suffering with dry eye can use artificial tears, in the form of eye drops, that keep the eye moist and helps to prevent pain. Punctal plugs that fit into the tear ducts may also be useful as they prevent water from leaving the eye, keeping it within the area and preventing the eye from drying out.
Laser eye surgery is one of the most common surgeries that takes place in the UK, and it’s also one of the safest surgeries. However, it is still a type of surgery, and it’s naive to assume that it won’t hurt. For many, though, the opportunity to have better eyesight, and to be able to get rid of troublesome glasses and contact lenses, far outweighs the temporary pain felt during the recovery process. Patients should certainly do their homework prior to surgery, but should not allow the concept of pain to deter them from something that could make a huge difference to their lives.