LASIK is rarely a good idea in thyroid patients

By Sean Henahan

A recent American Society of Cataract and Refractive Surgery meeting concluded that dry eye was the most commonly reported complication following LASIK, occurring in as many as 50% of cases.
Many LASIK surgeons now try to screen out patients with existing dry eye conditions. So how should patients with thyroid disease be handled?
Considering that thyroid disease patients are prone to dry eye conditions either as a result of the disease or treatments they undergo, most patients with thyroid disease should be discouraged from undergoing LASIK procedures, physicians told
EuroTimes.

Joseph Colin MD, University of Bordeaux, France.
“I do ask prospective patients if they have thyroid disease. A thyroid patient with dry-eye should not be considered suitable for LASIK. A thyroid patient with good lacrimal function may be considered if the disease is stable with or without treatment. LASIK is contra-indicated in thyroid patients who have undergone systemic corticotherapy or previous radiotherapy.”

Perry Binder MD, Gordon/Binder Vision Institute, La Jolla, California.
“Normally I do not ask prospective patients if they have thyroid disease. But if I suspect exophthalmos, I measure and ask. We normally shy away from current dry eye LASIK candidates if the condition is severe enough to require drops in the absence of contact lens wear. If there is no exposure or decreased blink excursion, one might consider LASIK in a thyroid patient with good lacrimal function. But if a patient has obvious thyroid eye disease and LASIK is elective, I suspect most surgeons would say to skip this case.”

Jorge Alio MD, Instituto Oftalmológico de Alicante, Spain.
“I do ask prospective LASIK patients if they have thyroid disease. Active Basedow's disease is a contra-indication for LASIK if there is superior eyelid retraction syndrome and a consecutive decrease in the frequency of blinking. Dry eye syndrome and inflammation of the corneal surface will create a problem postoperatively for these patients if LASIK is performed. In some cases, a thyroid patient with good lacrimal function might be considered for LASIK if absent the eyelid and blinking symptoms I’ve mentioned.”

David Granet MD, Director, Thyroid Eye Clinic, Shiley Eye Centre.
“The LASIK surgeon may be the only eye doctor the patient has seen for years. Therefore, the attentive LASIK surgeon might be the first person to diagnose thyroid disease in that patient. The urgeon will be doing that patient a huge favour by diagnosing thyroid eye disease. A patient with exposure or lid retraction is a poor candidate for LASIK. We know now that LASIK can contribute to dry eye. If someone already has symptoms of dry eye related to thyroid disease, I would be reluctant to recommend LASIK.”

Michael Knorz MD, University Clinic, Mannheim Germany.
“I feel LASIK for a patient with thyroid disease is no problem, as long as there are no ocular manifestations. I would not treat a patient with Basedow´s disease, that is, a patient with exophthalmos, lid retraction and so on.”

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