The Role of Anamnesis in Modern Ophthalmic Practice: a Clinical Case

Eyes’ dryness continues to be the most frequent complication after LASIK. As a rule, it disappear in the vast majority of patients during the first year after surgery. The conducted studies indicate that complaints of eyes’ dryness in the preoperative period significantly increase the risk of developing a severe form of dry eye syndrome in the postoperative period, especially in middle-aged women (45–59 years) and older. The clinical case presented in this article indicates the development of a severe form of dry eye syndrome after LASIK in a middle-aged patient receiving hormone replacement therapy for menopause, complaining of a feeling of dryness and discomfort in the eyes in the preoperative period, with intolerance to contact lenses and taking antidepressants in the absence of signs of severe dry eye in the preoperative period. Consequently, surgical intervention led to the development of the mentioned above condition. It is confirmed by the literature data indicating that the above factors can cause the development of a severe form of dry eye syndrome after LASIK. Taking into account the fact that tear production tests do not always correlate with the intensity of complaints of dryness, burning sensation, pain in the eyes, the most important component at the stage of deciding on the feasibility of refractive surgery in a particular patient is the collection of anamnesis and clinical picture. When preparing patients with a history of dry eye syndrome for refractive surgery, it is necessary to inform them that they have a significantly increased risk of developing dry eye syndrome. It may persist in the long-term postoperative period, and possibly go into a chronic form. Candidates for refractive surgery in the presence of complaints characteristic of dry eye syndrome can only be those patients who respond well to therapy aimed at relieving these symptoms in the preoperative period. Taking into account the multicomponent nature of pain in dry eye syndrome — nociceptive pain, which is formed at the stage of receptor irritation in the corneal tissue, and neuropathic pain that occurs with the participation of the peripheral and central nervous system, a comprehensive approach is needed in the treatment of dry eye syndrome.

1. Shtein RM. Post LASIK dry eye. Expert Rev Ophthalmol. 2011 Oct;6(5):575–582. DOI: 10.1586/eop.11.56

2. Solomon R, Donnenfeld ED, Perry HD. The effects of LASIK on the ocular surface. The Ocular Surface. 2004;2(1):34–44. DOI: 10.1016/S1542-0124(12)70022-8

3. Toda I. Laser assisted in situ keratomileusis for patients with dry eye. Archives of ophthalmology 2002;120(8):1024–1028.

4. Ambrósio R Jr, Tervo T, Wilson SE. LASIK associated dry eye and neurotrophic epitheliopathy: pathophysiology and strategies for prevention and treatment. J Refract Surg. 2008 Apr;24(4):396–407. DOI: 10.3928/1081597X-20080401-14

5. Shehadeh Mashor R, Mimouni M, Shapira Y, Sela T, Munzer G, Kaiserman I. Risk Factors for Dry Eye After Refractive Surgery. Cornea. 2019 Dec;38(12):1495–1499. DOI: 10.1097/ICO.0000000000002152

6. Schallhorn JM, Pelouskova M, Oldenburg C, Teenan D, Hannan SJ, Schallhorn SC. Effect of Gender and Procedure on Patient Reported Dry Eye Symptoms After Laser Vision Correction. J Refract Surg. 2019 Mar 1;35(3):161–168. DOI: 10.3928/1081597X-20190107-01

7. Gong Q, Li A, Chen L, Chen H, Gu J, Xu Z, Lu F, Hu L. Evaluation of Dry Eye After Refractive Surgery According to Preoperative Meibomian Gland Status. Front Med (Lausanne). 2022 Apr 25;9:833984. DOI: 10.3389/fmed.2022.833984

8. Nakatsuka AS, Mifflin MD. Response to “Risk Factors for Dry Eye After Refractive Surgery”. Cornea. 2020 Aug;39(8):e22. DOI: 10.1097/ICO.0000000000002360

9. Cohen E, Spierer O. Dry Eye Post Laser Assisted In Situ Keratomileusis: Major Review and Latest Updates. J Ophthalmol. 2018 Jan 28;2018:4903831. DOI: 10.1155/2018/4903831

10. Yu EY, Leung A, Rao S, Lam DS. Effect of laser in situ keratomileusis on tear stability. Ophthalmology. 2000 Dec;107(12):2131–2135. DOI: 10.1016/s0161-6420(00)00388-2

11. Li M, Zeng L, Mi S, Li Y, Liu Z, Yu K, Hu Q, Li H, Ma D, Zhou Y, Wang J, Guo X, Fang X, Bai J, Choi J, Zhou X. A Multicenter Study of the Prevalence of Dry Eye Disease in Chinese Refractive Surgery Candidates. Ophthalmic Res. 2021;64(2):224–229. DOI: 10.1159/000509060

12. Peng-Fei Zhao, Yue-Hua Zhou, Ya-Bin Hu, Kai Cao, Ying Qi, Ning Guo, Xu Gao, Qing-Wei Zhang, Chang-Bin Zhai. Evaluation of preoperative dry eye in people undergoing corneal refractive surgery to correct myopia. Int J Ophthalmol. 2021 Jul 18;14(7):1047–1051. DOI: 10.18240/ijo.2021.07.13. eCollection 2021.

13. Galor A, Feuer W, Lee DJ, Florez H, Carter D, Pouyeh B, Prunty WJ, Perez VL. Prevalence and risk factors of dry eye syndrome in a United States veterans affairs population. Am J Ophthalmol. 2011 Sep;152(3):377–384.e2. DOI: 10.1016/j.ajo.2011.02.026

14. Galor A, Felix ER, Feuer W, Shalabi N, Martin ER, Margolis TP, Sarantopoulos CD, Levitt RC. Dry eye symptoms align more closely to non-ocular conditions than to tear film parameters. Br J Ophthalmol. 2015 Aug;99(8):1126–1129. DOI: 10.1136/bjophthalmol-2014-306481

15. Pouyeh B, Viteri E, Feuer W, Lee DJ, Florez H, Fabian JA, Perez VL, Galor A. Impact of ocular surface symptoms on quality of life in a United States veterans affairs population. Am J Ophthalmol. 2012 Jun;153(6):1061–1066.e3. DOI: 10.1016/j.ajo.2011.11.030

16. Galor A, Feuer W, Lee DJ, Florez H, Faler AL, Zann KL, Perez VL. Depression, post-traumatic stress disorder, and dry eye syndrome: a study utilizing the national United States Veterans Affairs administrative database. Am J Ophthalmol. 2012 Aug;154(2):340–346.e2. DOI: 10.1016/j.ajo.2012.02.009

17. Fernandez CA, Galor A, Arheart KL, Musselman DL, Venincasa VD, Florez HJ, Lee DJ. Dry eye syndrome, posttraumatic stress disorder, and depression in an older male veteran population. Invest Ophthalmol Vis Sci. 2013 May 1;54(5):3666–3672. DOI: 10.1167/iovs.13 11635

18. Lee CJ, Felix ER, Levitt RC, Eddy C, Vanner EA, Feuer WJ, Sarantopoulos CD, Galor A. Traumatic brain injury, dry eye and comorbid pain diagnoses in US veterans. Br J Ophthalmol. 2018 May;102(5):667–673. DOI: 10.1136/bjophthalmol-2017-310509

19. Belmonte C, Acosta MC, Merayo Lloves J, Gallar J. What Causes Eye Pain? Curr Ophthalmol Rep. 2015;3(2):111–121. DOI: 10.1007/s40135-015-0073-9

20. Mcmonnies CW. The potential role of neuropathic mechanisms in dry eye syndromes. J Optom. 2017 Jan Mar;10(1):5–13. DOI: 10.1016/j.optom.2016.06.002

21. Vázquez A, Martínez-Plaza E, Fernández I, Sobas EM, González-García MJ, Enríquez-de-Salamanca A, Ortega E, López-Miguel A, Calonge M. Phenotypic characterization of patients developing chronic dry eye and pain after refractive surgery: A cross sectional study. Ocul Surf. 2022 Oct;26:63–74. DOI: 10.1016/j.jtos.2022.07.010

22. Moshirfar M, Rosen DB, Heiland MB, Ronquillo YC, Hoopes PC. Should I Get LASIK If I’m Breastfeeding? Ophthalmol Ther. 2019 Sep;8(3):349–352. DOI: 10.1007/s40123-019-0195-5

23. Wilkinson JM, Cozine EW, Kahn AR. Refractive Eye Surgery: Helping Patients Make Informed Decisions About LASIK. Am Fam Physician. 2017 May 15;95(10):637–644.

24. Rosenfeld SI. Evaluation and management of post-LASIK dry eye syndrome. Int Ophthalmol Clin. 2010 Summer;50(3):191–199. DOI: 10.1097/IIO.0b013e3181e2469b

25. Medvedev I.B., Trubilin V.N., Poluninа E.G., Dergacheva N.N., Andzhelova D.V., Evstigneeva Yu.V., Chinenova K.V. Modern Ideas about Dysfunction of the Meibomian Glands. Оphthalmology in Russia = Oftal’mologiya. 2022;19(2):359–367 (In Russ.). DOI: 10.18008/1816-5095-2022-2-359-367