DLK and Floaters!

[patrickchu]

Hello. I had lasik almost 3 weeks ago for both eyes and have developed DLK in the left eye in around the third day after the surgery. Since then I have been taking steroid both orally and drops into the eyes. My left eye vision is still blurred and is improving very slowly.

Another symptom after the surgery is that the number and sizes of floater has significantly increased. I am not sure if it has always been like this just that I was not as alert and aware (as the surgeon suggested) or it was induced thought the lasik operation.

My questions…

1. With my left eye, it seems that the vision can get clearer after I look at the object and try to focus for sometime (30 to 60 seconds). Does this mean that my ability to focus has decreased? Can I “train” it by covering my right eye? Anything else I can do to accelerate the recovery?

2. After DLK recovery, which I hope it will, is there anything I can do to reduce the probability of it reoccurring?

3. Could lasik increase floaters and retina problem>

Many thanks in advance for your advice.

[patrickchu]

DLK still persists. Morning vision is significantly better than that in the afternoon and evening. Any similar experience and advice?

[LasikExpert]

Diffuse Lamellar Keratitis (DLK) is an inflammatory response at the interface of the Lasik flap. Treatment is commonly steroid eye drops and oral steroids. If disgnosed and treated early, recovery is most likely assured. If DLK persists too long before adequate treatment the cornea may become hazy, which would reduce vision clarity. Your persistent symptoms of DLK are undoubtedly corneal haze due to the inflammatory response or induced myopia (nearsighted, shortsighted) vision due to inflammation. It is highly unlikely that you still have active DLK.

Another symptom after the surgery is that the number and sizes of floater has significantly increased. I am not sure if it has always been like this just that I was not as alert and aware (as the surgeon suggested) or it was induced thought the lasik operation.

Floaters are pieces of membrane of the inner components of the eye that float around in the jelly-like vitreous that fills the large back chamber of the eye. Floaters are common, however a large or sudden quantity can indicate other eye health issues and should always be reported to your doctor. The process of Lasik includes applying a large amount of pressure to the eye for a short time while the flap is made and this can disturb existing floaters and move them into the line of vision. Also, changes in the optics of the eye as a result of Lasik can make previously ignored floaters much more visible.

There really is no reliably viable treatment for common floaters, however the brain is very good at ignoring such imperfections. An example of this is the optic nerve. Everyone has a very large area without vision that corresponds with where the optic nerve enters the eye, but we don't "see" it because the brain has learned to ignore its presence.

1. With my left eye, it seems that the vision can get clearer after I look at the object and try to focus for sometime (30 to 60 seconds). Does this mean that my ability to focus has decreased? Can I “train” it by covering my right eye? Anything else I can do to accelerate the recovery?

It is not likely that your ability to change focus (accommodation) has lessened, but it undoubtedly has changed the range needed to focus. Read our article about Lasik and eye strain issues.

2. After DLK recovery, which I hope it will, is there anything I can do to reduce the probability of it reoccurring?

An avoidable cause of late-onset DLK reoccurring is trauma to the eye. Wear protective eye wear and don't get hit upside the head.

3. Could lasik increase floaters and retina problem

It is possible, but not probable. High myopia vision (around over 8.00 diopters) is a risk factor for retina detachment whether you have Lasik or not. A competent Lasik doctor will evaluate the health of the retina of a high myope before recommending surgery.

[patrickchu]

Thank you very much for your response Glenn. My DLK is almost gone now but due to the long period of medication, my eye is very dry and is therefore slightly wounded and inflammation at the surface of the corena. Hence, my vision is still very blurred. My doctor is continuing applying steriod to my affected fearing that the DLK might return. Is is normal practice? I trust the steriod is delaying my healing of the wound.

[LasikExpert]

My doctor is continuing applying steriod to my affected fearing that the DLK might return. Is is normal practice? I trust the steriod is delaying my healing of the wound.

It is common to keep a patient with DLK on steroids for an extended period of time and tapering the patient off the steroids over a period of days or weeks. Steroids control the wound response and reduce inflammation. The concern with steroids is that they can cause an elevation of intraocular pressure (IOP). IOP can be monitored and it takes quite a bit of time for damage to occur if IOP is elevated, allowing a change in treatment plan if required.

[patrickchu]

[*]

An avoidable cause of late-onset DLK reoccurring is trauma to the eye. Wear protective eye wear and don't get hit upside the head.

Thanks again for your response Glenn.
I have pending dental surgery, would this post a risk of DLK coming back? Also, I read on the web that there are a number of cases of late-onsite DLK happening when one is travelling overseas. Anything one can do to mitigate the risk?

Apart from DLK, I am also getting dry eyes problem with both eyes. Anything one can do to expedite the recovery?

[LasikExpert]

I have pending dental surgery, would this post a risk of DLK coming back?

There is nothing in the published literature that indicates an elevated risk during normal dental care, however be certain that you notify your dentist of the medications you are and you recently have been using.

Also, I read on the web that there are a number of cases of late-onsite DLK happening when one is travelling overseas. Anything one can do to mitigate the risk?

DLK is not limited by region, nor is one region of the world more suspecptable to DLK than another. The risk is the same wherever you are. The only thing you can mitigate is risky activity. Don't be kick boxing whether you are in Tokyo or Toledo.

Apart from DLK, I am also getting dry eyes problem with both eyes. Anything one can do to expedite the recovery?

There is much you can do to manage dry eyes after Lasik. See our article on dry eye treatment.

[patrickchu]

Glenn,
Since the problem of my cornea surface wound - caused by too much medication preservatives (and dry-eye?) - I have been covering my left eye with eye pad most of the time for protection and to keep it moist. The wounds has almost fully recovered now (together with the DLK) and my doctor has asked me to stop most of the drops except tears and a few more days of steriod. The question is that whenever I open my eye pad, the vision is very very clear, even better than my healthy right eye, but after an hour or two, even with tear drops applied, the vision will start to become a bit blurred. Is that normal? I told the same story to my doctor who did not comment much except saying that my wounds are almost cured.

[LasikExpert]

You are, in effect, over-hydrating your patched eye. This causes slight swelling of the corneal tissue, which will result in a change of refractive error. You also are eliminating any surface problems caused by dry eye. The combination dissipate after a few hours. Not until you have full healing will you know for certain the quality of your postoperative vision.

[patrickchu]

You are, in effect, over-hydrating your patched eye. This causes slight swelling of the corneal tissue, which will result in a change of refractive error. You also are eliminating any surface problems caused by dry eye. The combination dissipate after a few hours. Not until you have full healing will you know for certain the quality of your postoperative vision.

Glenn, do you mean that I should not be covering my eye because it causes over-hydration and swelling? I thought the patching was good protection against the very dry weather in these winter months. My doctor said that the wounds are alomst cured...only two very tiny dots left. I still cover it because I fear that the dry weather will cause wounds again.
BTW, Glenn, I really appreciate all your responses along. They are really helpfull. Thank you very much!

[patrickchu]

Are there any adverse effort on "overusing" preservative-free artifial tear or eye gel?

[LasikExpert]

Thank you for your kind words. I'm glad the information I provided has been helpful.

The eye patching seems to be promoting healing and your doctor has not advised you to stop. It makes sense to continue until you are fully healed. Once healed, removing the patch will allow the eye to stabilize tear production to actual need. This process may cause a small change in refractive error if the corneal hydration changes. It will be interesting to hear from you what, if any, effect you find from stopping the patching.

Unless there is an allergic reaction to the active agent, over-use of preservative free artificial tears is not likely to cause long-term problems. Excessive tears flow out the punctum or otherwise expel from the eye. Over-use of preserved tears can cause all sorts of problems. Preservatives are a toxin. They are there to kill the bugs you don't want in your eye drops. Unfortunately they are not just a toxin to the bugs, but also to other sensitive tissue. Putting too much toxin in your eyes too often is seldom a good idea.

[patrickchu]

Thank you for your kind words. I'm glad the information I provided has been helpful.

The eye patching seems to be promoting healing and your doctor has not advised you to stop. It makes sense to continue until you are fully healed. Once healed, removing the patch will allow the eye to stabilize tear production to actual need. This process may cause a small change in refractive error if the corneal hydration changes. It will be interesting to hear from you what, if any, effect you find from stopping the patching.

Unless there is an allergic reaction to the active agent, over-use of preservative free artificial tears is not likely to cause long-term problems. Excessive tears flow out the punctum or otherwise expel from the eye. Over-use of preserved tears can cause all sorts of problems. Preservatives are a toxin. They are there to kill the bugs you don't want in your eye drops. Unfortunately they are not just a toxin to the bugs, but also to other sensitive tissue. Putting too much toxin in your eyes too often is seldom a good idea.

Glenn, my doctors did not asked me to do the patching. I kind of "invented" that myself and they didn't object. I have not been doing the patching all the time these couple of days (unless you advise otherwise) because I feel that the eye is sometimes getting too wet (maybe psychological since I read you earlier post about swelling corenal tissue). Anyway, this morning, after having it unpatched for an hour or so, with the little burred vision, I went to a local optometrist to check my vision. The result was that I have in my right (good) eye +0.50 with astigmatism -0.50 and in my left (bad) eye -0.50 with astigmatism -0.75. I hope the astigmatism does not suggest that the cornea surface wounds and/or inflammation has returned (would it?). I hope Iit really should not because my right eye which had dlk for only a few days after the operation two months ago also have astigmatism. There are another five days before I will see my doctor again..

[LasikExpert]

Glenn, my doctors did not asked me to do the patching.

I'm not surprised. I can only imagine most patients' reaction if told to patch their Lasik eye. It may be a good idea coming from the patient, but a worrisome idea coming from the doctor.

I have not been doing the patching all the time these couple of days (unless you advise otherwise) because I feel that the eye is sometimes getting too wet (maybe psychological since I read you earlier post about swelling corenal tissue).

The value of my lay opinion is low on the scale when compared to the opinion of your doctor who has the medical knowledge and who actually saw your eye.

I hope the astigmatism does not suggest that the cornea surface wounds and/or inflammation has returned (would it?).

Not necessarily. This can be regular astigmatism that was not removed during the surgery or even induced during the surgery. Yes, localized inflammation can induce or exacerbate astigmatism, but normally that is irregular astigmatism and the eye doctor would undoubtedly had noted irregular astigmatism.

I hope Iit really should not because my right eye which had dlk for only a few days after the operation two months ago also have astigmatism. There are another five days before I will see my doctor again..

Other than the stress of worrying about your eyes, it seems that you are on the mend and headed in the right direction. I look forward to hearing what your doctor says next week.

[patrickchu]

Other than the stress of worrying about your eyes, it seems that you are on the mend and headed in the right direction. I look forward to hearing what your doctor says next week.

You are right Glenn. The doctor confirmed that the DLK and corena surface wounds and inflammation are all gone. Even the IOP has dropped due to my stopping of steriod (though I am still on "anti-IOP" for another couple of days). However, the doctor cannot explain why the wetting of my dry eye would immediately gives very clear vision (for a while until it gets dry again). I suspect that the previous wounding of the surface of the corena, although now healed, has introduced an uneven corena surface and hence the astigmatism. I am guessing that the wetting of the eye would temporarily smooth the surface and hence a while of clear vision.
I wonder if my astigmatism will eventually go away either with my tears coming back (hopefully soon) or if the corenea will grow and get to its smooth original self again (if my guess on the uneven corena surface was right)...