After laser eye surgery, many people can finally see clearly – without glasses or contact lenses.
However, as fascinating as the prospect of a life with sharp vision is, there are aspects that need to be well thought through.
One of the most common questions patients ask is: “What happens if inflammation occursafter laser eye surgery?” In this blog post, we take a deep dive into the topic and shed light on what exactly inflammation after laser eye surgery means, how often it occurs and what symptoms may indicate it.
You will also find out what preventative measures you can take to avoid complications and what treatmentsare available if an infection does occur.

What is inflammation after laser eye surgery?

Inflammation after laser eye surgery is a reaction of the body to the procedure on the sensitive cornea of theeye.
This inflammation can occur as a complication and is triggered by the immune system reacting to the changes caused by the laser treatment.
Although modern methods of refractive surgery, such as LASIK or SmartSight, are extremely precise and safe, there are still potential risks and side effects.
After laser eye surgery, the eye can be particularly susceptible to infection and inflammation as the surface of the cornea is altered by the lifting of the flap (with LASIK) or ablation with the laser (with other methods). These inflammatory reactions are usually mild and temporary, but in rare cases can lead to more severe symptoms such as swollen eyes, dry eyes or even blurred vision.

How often this side effect occurs: LASIK treatment, SmartSight & Co

Inflammation as a side effect after laser eye surgery is rare, but still a possible risk.
The frequency varies depending on the method of laser eye treatment.
Modern techniques such as LASIK, SmartSight and Trans-PRK have an extremely low complication rate.
Studies show that serious complications such as infectious inflammation occur in less than 1% of cases.
Minor inflammatory reactions caused by dry eyes or irritation are slightly more common, but affect only a small percentage of patients and usually resolve within a few days. LASIK, one of the most commonly performed laser eye surgeries, has a known but low rate of post-operative inflammation.
This is estimated to occur in 1 to 2% of patients, making it one of the safest laser eye surgeries.
With SmartSight(ReLEx SMILE), a newer and minimally invasive method, the rates are even lower. As this method does not require the creation of a flap, the risk of complications such as inflammation is further minimized.
Trans-PRK, a superficial method in which the surface of the cornea is treated directly, also shows a low incidence of inflammation, but symptoms such as dry eyes or sensitivity to light may occur slightly more frequently in the first few days after the operation due to the directly treated corneal surface.

Causes of inflammation as a complication:

Inflammation after laser eye surgery can be caused by a variety of factors.
Although these complications are rare, it is important to understand the possible causes to minimize the risk.
Here are the main causes of inflammation after laser eye surgery:

• Bacterial infection: One of the most common causes of inflammation is the entry of bacteria into the eye during or after surgery.
  This can happen if the post-operative care instructions are not strictly followed or if germs get into the wound.
• Dry eyes: Dry eyes after laser treatment can lead to micro-tears on the surface of the cornea, which increases the risk of inflammation. Dry eyes caused by laser treatment are a common side effect andcan make the eye more susceptible to irritation and infection.
• Foreign bodies in the eye: Small particles such as dust or tiny fibers that enter the eye after surgery can irritate the cornea and trigger an inflammatory reaction.
• Incomplete healing of the flap: During LASIK treatment, a flap is created in the cornea, which is put back in place after the procedure.
  If this flap does not heal correctly or is displaced, this can lead to inflammation.
• Overreaction of the immune system: In some cases, the body’s immune system overreacts to the procedure and tries to fight the treated cornea as foreign tissue.
  This can lead to a sterile inflammation in which no bacteria are involved.
• Lack of moisture in the eyes: Insufficient moisture in the eyes after laser eye treatment can dry out the corneaand cause tears or inflammation.
  The use of artificial tears helps to minimize this risk.
• Postoperative hygiene problems: Touching the eyes with unwashed hands or using non-sterile eye drops can introduce bacteria into the eye and cause inflammation.
• Pre-existing eye diseases: Patients with pre-existing conditions such as keratoconus or chronic lid margin inflammation have a higher risk of post-operative inflammation as their cornea is already weakened or irritated.
• Overexertion of the eye after surgery: Intense visual strain, such as working at a computer for long periods or reading in dim light, can delay healing and promote inflammation, especially in the first few days after surgery.

Symptoms of inflammation during or after laser eye surgery

• Redness of the eye: Intense redness of the eye, especially the cornea or the surrounding area, can indicate inflammation.
  This redness is caused by increased blood flow to the inflamed tissue.
• Pain or pressure: Patients may experience an unpleasant sensation of pain or pressure in the eye, which is not normal and may indicate inflammation.
  This pain may be constant or occur with eye movement.
• Sensitivity to light: Increased sensitivity to light is a common symptom after laser eye surgery, but it can be particularly pronounced in the case of inflammation.
  Even normal daylight can then be perceived as unpleasant.
• Blurred vision: Blurred vision or a sudden deterioration in visual acuity can be signs that the cornea is inflamed.
  This is particularly worrying if vision deteriorates again in the first few days after laser surgery .
• Excessive watering: Watery eyes are a normal reaction after laser eye surgery, but if the eye tears excessively and does not stop, this could be an indication of inflammation.
• Itchy eyes: Severe itching in the operated eye may indicate inflammation or an incipient infection.
  It is important not to rub the eye so as not to aggravate the inflammation.
• Swelling of the eyelids: Swollen eyes or eyelids are another sign of inflammation.
  This swelling can make it difficult to open and close the eye and should be monitored.
• Foreign body sensation: A constant feeling that there is something in the eye, even though nothing can be seen, can be a symptom of inflammation orirritation of the cornea.
• Halos and double vision: The perception of halos (rings of light) or double vision can also be caused by inflammation.
  These symptoms can particularly impair night vision.
• Clouding of the cornea: Inflammation can also lead to clouding of the cornea, which impairs vision and may be visible on close inspection.

How can the risk of inflammation after laser eye surgery be minimized?

1. Strict adherence to post-operative instructions: One of the most important factors in avoiding inflammation is following the instructions given by the ophthalmologist after laser eye surgery to the letter.
   This includes the regular use of anti-inflammatory eye drops and antibiotic drops to prevent infection.
2. Use of sterile eye drops: It is essential that all prescribed eye drops and ointments are sterile and used exactly as prescribed.
   Touching the eye drop opening with hands or other surfaces should be avoided to prevent bacteria from entering the eye.
3. Avoid rubbing your eyes: After laser eye surgery, it is especially important not to rub your eyes, even if an itchy or foreign body sensation occurs.
   Rubbing can displace the flap (in the case of LASIK) or irritate the cornea, which increases the risk of inflammation.
4. Keep your hands clean: As the eyes are particularly sensitive after the procedure, care should be taken to wash hands regularly and not bring them close to the eyes to reduce the risk of infection.
5. Avoidance of potential irritants: In the first few days after laser eye surgery, contact with irritants such as dust, smoke or chemicals should be avoided.
   These can irritate the cornea and trigger inflammation.
6. Wearing protective goggles: To protect the eyes from accidental bumps or the ingress of foreign bodies, it is often recommended to wear protective goggles in the first few days after the operation, especially when sleeping or in dusty environments.
7. Careful choice of ophthalmologist: Choosing an experienced and reputable ophthalmologist or clinic can significantlyreduce the risk of complications.
   An experienced surgeon will not only perform the procedure with precision, but will also ensure thorough aftercare.
8. Compliance with follow-up appointments: Regular follow-up visits to the ophthalmologist after laser surgery are crucial to monitor the healing process and to detect and treat possible inflammation at an early stage.
9. Avoidance of intensive physical activity: Strenuous physical activity should be avoided in the first few weeks after laser eye surgery, as this could impair the healing process and increase the risk of inflammation.
10. Adequate eye moisture: Dry eyes are a common side effect after laser eye surgery and can lead to inflammation.
    Regular use of artificial tears helps to maintain eye moisture and protect the cornea.
11. Avoid make-up and cosmetics: In the first few days after surgery, eye make-up or other cosmetics should not be worn in order to minimize the risk of irritation and infection.

Treatment of the eye in case of infection / inflammation

If an infection occurs in the eye after laser eye surgery, it is important to act quickly to prevent permanent damage and worsening.
There are different treatment approaches in modern medicine, each of which is tailored to the cause.

Use of anti-inflammatory eye drops

Anti-inflammatory eye drops play a central role in the treatment of inflammation after laser eye surgery such as LASIK.
These drops are used to control the inflammatory reactions in the eyeand support the healing process.

Why anti-inflammatory eye drops are important:

• Reduction of swelling and redness: After a procedure such as laser eye surgery, the eye may swell or redden slightly due to the manipulation of the cornea. Anti-inflammatory eye drops help to alleviate these symptoms by reducing the body’s immune response to the trauma of the procedure.
• Prevention of serious complications: If inflammation is left untreated, it can lead to serious complications, such as clouding of the cornea or even loss of visual acuity.
  Regular use of anti-inflammatory drops helps to minimize such risks.
• Relief of discomfort: Symptoms such as sensitivity to light, itching and an unpleasant feeling in the eye can be significantly reduced by using these drops.
  This makes the healing process more pleasantfor the patientand promotes rapid recovery.
• Supporting the healing process: By reducing inflammation, the natural healing process is accelerated. Anti-inflammatory eye drops help to ensure that the corneal tissue can regenerate optimally without being disturbed by an excessive immune reaction.

Types of anti-inflammatory eye drops:

• Steroidal eye drops: These drops contain corticosteroids, which are particularly effective in combating severe inflammation.
  They are often prescribed shortly after laser eye surgery and then gradually discontinued so as not tostrain the eyefor too long.
• Non-steroidal anti-inflammatory eye drops (NSAIDs): These drops provide an anti-inflammatory effect without the side effects of steroids.
  They are often used in milder cases or when prolonged treatment is required.

Use and precautions:

• Dosage and application: The ophthalmologist will prescribe an exact dosage and frequency of application, which should be strictly adhered to.
  Typically, the drops are administered several times a day over a period of days to weeks, depending on the severity of the inflammation.
• Possible side effects: Although anti-inflammatory eye drops are very effective, in rare cases they can cause side effects such as increased intraocular pressure, burning sensation or a temporary deterioration in vision.
  The patient should report any unusual reaction to the ophthalmologist immediately.
• Avoid long-term use: Steroidal eye drops should not be used over a long period of time as they can increase the risk of side effects such as increased intraocular pressure or thinning of the cornea.
  Therefore, the ophthalmologist will gradually reduce the treatment once the inflammation is under control.

Antibiotic eye drops or ointments

Why antibiotic eye drops and ointments are necessary:

• Prevention of bacterial infections: After laser eye surgery such as LASIK or SmartSight, the eye is particularly susceptible to bacterial infections as the cornea is temporarily weakened by the procedure. Antibiotic eye dropshave a preventative effect by killing potentially dangerous bacteria before they can cause an infection.
• Treatment of existing infections: If signs of infection occur after surgery, such as redness, swelling or pus formation, antibiotic drops or ointments are the first line of defense.
  They fight the bacteria directly on the surface of the cornea and prevent the infection from spreading further.
• Rapid effect for acute infections: The direct application of antibiotic agents to the eye ensures that the medication acts quickly and can fight the infection efficiently.
  This is particularly important to prevent permanent damage to the cornea.

Types of antibiotic eye drops and ointments:

• Broad-spectrum antibiotics: These types of antibiotics are often used prophylactically or for unclear bacterial infections as they are effective against a wide range of bacterial strains.
  They are the standard treatment after many laser eye surgeries.
• Specific antibiotics: In the case of known or suspected specific bacterial infections, the ophthalmologist can prescribe targeted antibiotics that are particularly effective against the identified bacteria.
• Combination preparations: Sometimes antibiotics are combined with anti-inflammatory agents to combat both the bacterial infection and the associated inflammation.
  These preparations can be administered as drops or ointments and are particularly useful in cases where both problems occur simultaneously.

Use and precautions:

• Regular and correct application: Antibiotic eye drops and ointments must be applied at the intervals specified by the ophthalmologist.
  Irregular application can reduce the effectiveness and lead to the development of resistant bacteria.
  Drops are usually administered several times a day, while ointments, which adhere longer, often only need to be applied once or twice a day.
• Sterile handling: To avoid further infection, it is important to keep the drops and ointments sterile.
  The tip of the bottle or tube should not touch the eye or other surfaces.
  Hands should be washed thoroughly before each application.
• Possible side effects: Although rare, antibiotic eye drops and ointments can cause side effects such as burning, irritation or allergic reactions.
  In rare cases, hypersensitivity to the antibiotic may occur, which should be reported to the ophthalmologist immediately.
• Duration of use: Antibiotics should be used for as long as prescribed by the ophthalmologist, even if the symptoms have already disappeared.
  Premature discontinuation may result in the infection not healing completely and recurring.
• Combination with other medications: Antibiotic eye drops can be used in combination with other medications, such as anti-inflammatory eye drops.
  The ophthalmologist will determine the exact treatment plan to ensure that the different medications do not interfere with each other.

Artificial tears

• Moisturizing effect: Artificial tears moisturize the surface of the cornea, which is particularly important after laser eye treatment.
  A well-moisturized eye is less susceptible to micro tears and irritation, which could otherwise increase the risk of inflammation.
• Reduction of irritation: The eyes can be particularly sensitive after laser eye surgery. Artificial tears help to minimize irritation caused by environmental influences such as dust, smoke or dry air.
  This prevents the eye from becoming irritated and inflammation from developing.
• Promotes healing: A constantly moist environment supports the healing process of the cornea. Artificial tears ensure that the eye ‘s natural protective barrier is maintained and the risk of infection and inflammationis reduced.

Types of artificial tears and their application:

• Preservative-free drops: These are particularly recommended after laser eye surgery as they do not contain any additional chemicals that could irritate the eye.
  They are ideal for frequent use and for people with sensitive eyes.
• Gels and viscous drops: These preparations adhere longer to the surface of the cornea and therefore provide long-lasting moisture.
  They are particularly suitable for use before going to bed to protect the eye overnight.
• Single-use doses: Single-use doses offer the advantage that they are always sterile and contain no preservatives.
  They are particularly practical when traveling and reduce the risk of infection.

Invasive interventions in severe cases

In rare cases, inflammation following laser eye surgery can be so severe that it does not respond adequately to conservative treatments such as antibiotic and anti-inflammatory eye drops.
In such situations, invasive procedures may be required to control the inflammation and protect the eye from permanent damage.

When are invasive procedures necessary?

• Persistent or worsening inflammation: If an inflammation does not subside or worsens despite intensive drug therapy, more invasive treatment must be considered.
  This is often the case with severe bacterial infections that do not respond to antibiotics.
• Formation of corneal ulcers: In very severe infections, a corneal ulcer can form, seriously compromising the structure and transparency of the cornea.
  In such cases, the infected tissue may need to be removed to stop the inflammation and save the cornea.
• Keratectasia or other structural complications: Keratectasia (protrusion of the cornea due to weakening) or other structural changes to the cornea following inflammation may require invasive measures to stabilize and preserve vision.

Possible invasive interventions:

• Corneal debridement: During debridement, the inflamed or infected epithelial tissue of the cornea is removed to expose the underlying healthy tissue.
  This promotes healing and helps to reduce inflammation.
  It is often performed when a superficial infection is the cause of the inflammation.
• Corneal transplantation (keratoplasty): In extreme cases where the cornea has been irreparably damaged by the inflammation, a corneal transplant may be necessary.
  This involves replacing the damaged tissue with a healthy cornea from adonor.
  This measure is only considered in exceptional cases when all other treatments have failed.
• Intraocular injections: In cases of severe inflammation that spreads to the inside of the eye (e.g. endophthalmitis), injections of antibiotics or anti-inflammatory medication directly into the eye may be necessary.
  This measure is taken if systemic therapy is not sufficient to control the infection.
• Therapeutic contact lenses: In some cases, special therapeutic contact lenses can be used to protect the cornea and support healing after an invasive procedure.
  These lenses can help to relieve pain and promote tissue regeneration.
• Corneal stroma injections: For specific inflammatory conditions of the cornea, it may be necessary to inject medication directly into the corneal stroma.
  This enables targeted treatment of deep-seated inflammation that cannot be reached by superficial drops.