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Allergic complications with laser-assisted in-situ keratomileusis

Bielory, Brett P.; O’Brien, Terrence P.

Current Opinion in Allergy & Clinical Immunology: October 2011 - Volume 11 - Issue 5 - p 483–491
doi: 10.1097/ACI.0b013e32834a4e01
Eye allergy: Edited by Leonard Bielory and Stefano Bonini

Purpose of review: This article reviews the complications of laser-assisted in-situ keratomileusis (LASIK) associated with ocular allergy. This review will provide guidance and heighten the need for a more comprehensive allergic evaluation before recommending LASIK procedure to patients. The material provided allows enhanced awareness of the potential postsurgical effects on allergic responses of the ocular surface and management thereof.

Recent findings: Ocular allergy is often underdiagnosed and has been previously reported only in a handful of peer-reviewed journals as the cause for ocular irritation and visual morbidity in post-LASIK dry eye disease. Diffuse lamellar keratitis is one complication of LASIK that has been linked to atopic individuals. LASIK causes significant inflammation in normal eyes, which is only exacerbated in atopic patients. Atopy may be a contributing factor in patients with patients with post-LASIK dry eye symptoms. Further investigation is required to better understand the complications of LASIK in allergic patients.

Summary: LASIK surgery has been associated with increased anterior surface inflammatory processes that include dry eye syndromes and ocular allergy. In addition, poorer outcomes of LASIK procedures have been reported in patients with moderate to severe ocular allergies and chronic forms of allergic conjunctivitis, which is an absolute contraindication to the LASIK procedure. We propose preoperative and postoperative management algorithms for allergic LASIK candidates.

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami – Miller School of Medicine, Palm Beach Gardens, Florida, USA

Correspondence to Terrence P. O’Brien, MD, Bascom Palmer Eye Institute (Palm Beach Campus), University of Miami – Miller School of Medicine, 7101 Fairway Drive, Palm Beach Gardens, FL 33418, USATel: +1 561 515 1544; fax: +1 561 355 8600; e-mail: tobrien@med.miami.edu

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