A Transient Light Sensitivity Case After A Successful Lasik Treatment: Can The Epithelium Play A Crucial Role?

To describe a case of immediate and persistent post-operative light sensitivity in a patient that underwent an uncomplicated femto-LASIK treatment for a moderate compound myopic astigmatism.

The surgery was done in December 2023 in a private practice laser clinic (Day Surgery Center) in Naples (Italy), using a Ziemer Z8 femto-Laser (Ziemer Ophthalmic Systems AG) and a Technolas Teneo excimer-laser (Bausch + Lomb Inc.).

A 38-yo female with a moderate compound myopic astigmatism underwent refractive surgery. Her medical history was unremarkable, excepted for a well-controlled mild thyroid dysfunction (due to Hashimoto's disease). A complete pre-op assessment only showed a mild lacrimal dysfunction with an asymptomatic dryness (NI-BUT < 12s). A pre-surgical therapy with artificial tears was prescribed in order to resolve the dryness before surgery. A femto-LASIK was done in December 2023, without intra-operative complications. The day after UCVA was 20/20 in both eyes, flap was well unfolded and transparent, without striae or debris in the interface. Since the first moments after the procedure was completed, a disabling light sensitivity was reported by the patient, mainly for artificial lights and monitors. Symptoms didn’t disappear with therapy in the days after and for this reason other examinations were done after two and four weeks of therapy with topical costicosteroids and artificial tears, without resolution of the symptoms. The diagnose of suspect transient light sensitivity was done. We decided to study the corneal epithelium with an AS-OCT, since all other examinations were normal, and an epithelial map showed multiple abnormalities with crumbling all over the flap extension. A neurotrophic therapy was prescribed with autologous serum eye drops with epithelial improvement and resolution of symptoms.

Corneal Epithelium irregularities can be the cause of a transient light sensitivity after femto-LASIK procedures. Artificial tears and topical steroids may be insufficient to treat this condition and autologous serum or amniotic membrane eye drops should be considered to treat it. A light epithelial scattering is our hypothesis to explain the clinical picture and neurotrophic agents may be the solution.