- SMILE is a minimally invasive laser eye surgery that corrects myopia and astigmatism through a small incision, without creating a corneal flap.
- Because fewer corneal nerves are disrupted compared to LASIK, SMILE carries a significantly lower risk of post-operative dry eyes.
- Some temporary dryness after SMILE is normal and expected, but typically resolves within weeks to a few months.
- Patients with existing dry eyes may still be suitable for SMILE, though surgery may be delayed until the condition is stabilised.
- Following your surgeon’s aftercare instructions is the most effective way to minimise dry eye symptoms during recovery.
SMILE (Small Incision Lenticule Extraction) is a type of laser eye surgery designed to correct myopia (nearsightedness) and astigmatism, the latter being a condition where the cornea is not perfectly round, causing blurred or distorted vision. The procedure uses a femtosecond laser to create a tiny incision and remove a small disc of corneal tissue called a lenticule through it, reshaping the cornea and improving focus.
Compared to other procedures such as LASIK, SMILE has less impact on the structure of the cornea. As a result, patients generally experience less post-operative discomfort and a faster recovery.
How SMILE Surgery Minimises Dry Eye Risks Compared to LASIK
Dry eyes occur when tear production is insufficient or the quality of the tear film is disrupted, causing itching, grittiness, or a burning sensation. This condition can be triggered or worsened by eye surgery, though the degree of impact varies significantly between procedures.
LASIK creates a corneal flap, which is folded back to allow laser reshaping of the underlying tissue before being repositioned. This process affects a greater number of corneal nerves and therefore carries a higher risk of dry eyes developing during the healing period.
SMILE, by contrast, requires only a tiny incision of a few millimetres. Because the procedure is far less invasive, minimal corneal nerve disruption occurs, and the natural production of tears is affected much less. This makes SMILE a significantly better option for patients who are prone to dry eyes or who are frequent contact lens wearers, a group in which dry eye is particularly common.
Why Temporary Dryness Happens After SMILE
Some degree of post-operative dryness is a common side effect of all types of laser eye surgery. Any incision in the corneal surface can affect the nerves responsible for tear production, and the healing process itself can cause temporary inflammation that compounds dryness.
Changes to the tear film composition and a temporary reduction in tear volume are both possible following SMILE. Symptoms may include light sensitivity, blurred vision, a stinging sensation, and a feeling of grittiness. These can be more pronounced in patients who already experience dry eyes before surgery.
The good news is that these effects are typically temporary and diminish steadily as the eye heals. Because SMILE causes less corneal disruption than LASIK, the onset of dry eye symptoms is less likely and generally milder.
Managing Dry Eye Symptoms During Your Recovery Period
Several steps can be taken before and after surgery to minimise the risk and severity of dry eye symptoms:
- Have a comprehensive eye examination before surgery so any pre-existing conditions can be identified and managed in advance.
- Apply lubricating eye drops as directed to keep the eyes hydrated and comfortable.
- Stay well hydrated and consider using a humidifier at home to maintain moisture in your environment.
- Use warm compresses on the eyes to stimulate the oil glands and support tear quality.
- Limit screen time and take regular breaks to reduce eye strain during recovery.
- Wear sunglasses outdoors, particularly in sunny or windy conditions that can worsen dryness.
- Avoid activities that risk eye contact or impact, such as contact sports, during the healing period.
- Omega-3 supplements may help support tear production and reduce inflammation.
- In some cases, punctal plugs may be recommended to block tear drainage and retain moisture.
Strict adherence to your surgeon’s aftercare instructions is the most important thing you can do to support healing and minimise complications. If redness, blurred vision, or significant discomfort persists, contact your clinical team promptly.
Who is the Ideal Candidate for SMILE if You Already Have Dry Eyes?
An existing dry eye condition does not necessarily prevent you from having SMILE surgery. Because SMILE is considerably less invasive than LASIK, a broader range of patients with dry eye are suitable candidates.
SMILE is often preferred over LASIK for patients with dry eyes, including many frequent contact lens wearers. Surgeons will typically assess the severity of the condition and, where necessary, treat the underlying causes before proceeding with surgery.
However, surgery may be delayed in certain circumstances, including:
- When dry eye is related to an underlying systemic condition, such as an autoimmune disorder, that requires management first.
- When contact lenses are causing ongoing irritation to the eyes.
- When the tear film is highly unstable.
- When there is active corneal damage or inflammation.
These situations do not rule out SMILE surgery but may mean a short delay until conditions improve and the eyes are ready for the procedure.
Long-Term Outlook: When Will Your Tear Film Return to Normal?
SMILE is an extremely safe and effective treatment for myopia and astigmatism. Its minimally invasive nature reduces the risk of complications and supports a shorter recovery period compared to other laser procedures. Nevertheless, as with any surgery, some side effects are possible, and dry eyes are among the most common.
For most patients, dry eye symptoms after SMILE diminish within a few weeks as the eyes heal. In some cases, recovery of the tear film may extend to a few months, and for a small number of patients, ongoing management may be needed. Your surgeon will monitor your recovery and advise on the best approach if symptoms persist.
Dry eyes should not prevent you from considering SMILE surgery. Book a free consultation at ScottHyver Visioncare and our team will assess your eyes, discuss your history, and recommend the most suitable treatment approach for you.
Frequently Asked Questions
Does SMILE cause dry eyes?
SMILE can cause some temporary dryness following surgery, as is common with all types of laser eye procedures. However, because SMILE does not create a corneal flap and disrupts far fewer corneal nerves than LASIK, the risk of dry eyes is significantly lower. Symptoms that do occur typically resolve within weeks to a few months.
Can I have SMILE if I already have dry eyes?
In many cases, yes. SMILE is often the preferred option for patients with existing dry eyes precisely because it is less disruptive to the corneal surface than LASIK. However, if the condition is severe or related to an underlying health issue, your surgeon may recommend treating the dry eye first before proceeding with surgery.
How long do dry eye symptoms last after SMILE?
Most patients find that any dryness or related symptoms diminish within a few weeks of surgery. In some cases it may take a few months for the tear film to fully normalise. Lubricating eye drops and other aftercare measures can help manage symptoms during this period.
Is SMILE or LASIK better for dry eyes?
SMILE is generally considered the better option for patients who have or are at risk of dry eyes. Because it uses a much smaller incision and does not create a corneal flap, fewer nerves are affected and the impact on tear production is considerably less than with LASIK. Our ophthalmologists will assess your individual situation and recommend the most appropriate procedure.
