Question: I saw my eye surgeon for a LASIK pre-op appointment this morning. My Schirmer test came back at a 5 in each eye. I haven't felt like I had dry eyes until the last couple of months, when I've been up at night with our newborn baby. The surgeon says it's probably just because of the lack of sleep and gave me some Restasis and recommended that I go ahead with the procedure later this week (but said it would be OK if I want to wait). If I go ahead, he said he would just give me plugs on the day of the surgery and continue the Restasis for a month or two after the surgery and that I'd be fine. I wonder if you might have a second opinion to offer on whether I should proceed or if I should wait (possibly months) until my baby sleeps better and I have a chance to see if it's sleep or something else?
Answer: Congratulations on your newborn baby! You do not say how long post partum you are at this moment or whether you are nursing the baby. As you know, pregnancy and nursing can have a significant effect on hormones. These hormones and specifically the shifts in estrogen levels are a known cause of dry eye. Further, as hormones shift they can also cause changes in corneal thickness and make the stability of LASIK a little less predictable. The treatment of your dry eye complaints with punctal plugs and Restasis sounds like a typical clinical path that produces good results. In many cases of patients with modestly dry eyes they have plugs and Restasis 2-6 weeks prior to their surgery date as it takes Restasis some 4 weeks or more to produce its full effects. The conservative course is to wait until your dry eye is treated and stable BEFORE proceeding with LASIK and for may it is required that you not be nursing for 3-6 months before LASIK to allow the hormones to be fully stable as well.
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