Is PRK Surgery Safe for Dry Eyes?

If you’re living with dry eyes and thinking about laser vision correction, you’ve probably come across a lot of conflicting advice. Maybe you’ve heard that LASIK can worsen dry eye symptoms or that you’re automatically unsuitable for laser treatment altogether. Many people assume dry eyes rule them out completely but that isn’t true. In many cases, PRK (Photorefractive Keratectomy) is actually one of the safest and most appropriate options for people with dryness.

I’ve spoken with countless patients who were told that LASIK wasn’t suitable because their tear film was unstable or their corneas were too dry, only to later discover that PRK could still give them clear, comfortable vision without worsening their symptoms long-term. It’s a procedure that avoids creating a corneal flap and can therefore be better tolerated by dry-eye–prone eyes, especially as we get older or spend long periods on digital devices.

In this guide, I want to walk you through exactly why PRK is considered safer for dry eyes, how it affects the tear film, what you can expect during recovery, and how to decide whether it’s the right procedure for you.

Why Dry Eyes Matter in Laser Vision Correction

Dry eyes aren’t just a minor inconvenience they play a major role in how your vision stabilises after surgery. Your tear film is the first refractive surface of your eye, meaning it influences how crisp and clear your vision appears. If the tear layer is unstable, your eyesight can fluctuate or feel blurry.

Dry eyes can cause:

• Burning or stinging
• Grittiness
• Blurred vision
• Eye fatigue
• Fluctuating clarity
• Light sensitivity
• Difficulty wearing contact lenses

When laser surgery enters the picture, a dry eye assessment becomes even more important.

Why LASIK Can Make Dry Eyes Worse

Many people with dry eyes are advised against LASIK, and here’s why.

During LASIK, a flap is created in the cornea. This process disrupts the corneal nerves that help regulate tear production. When these nerves are cut, the eye may not realise it’s dry, so it produces fewer tears.

Effects of LASIK on dry eyes:

• Nerve disruption
• Reduced tear reflex
• Temporary inflammation
• More fluctuating vision in dry-eye–prone patients
• Higher risk of symptoms during the early months

For people with pre-existing dryness, this can make symptoms noticeably worse, even if the surgery itself is safe.

This is where PRK becomes a better alternative.

Why PRK Is Often Safer for Dry Eyes

PRK is a surface-based procedure, meaning no flap is created. Instead, the outermost corneal layer (epithelium) is removed and later regenerates naturally.

Benefits for dry-eye patients:

• No flap = fewer nerves disrupted
• Tear film tends to stabilise faster
• Lower risk of long-term dryness
• Corneal surface remains structurally stronger
• More comfortable for patients with borderline tear function

PRK still affects the tear film temporarily, but the overall impact is generally less severe than LASIK.

How PRK Works

Understanding the procedure can help you see why it’s often recommended for dryness.

Steps of PRK:

1. The epithelium is gently removed.
2. A laser reshapes the cornea to correct the prescription.
3. A bandage contact lens is placed on the eye while the epithelium heals.
4. The surface regenerates over 3–5 days.
5. Vision gradually improves over the following weeks.

Because the corneal nerves responsible for tear reflex sit deeper than the surface, PRK interferes with fewer nerves compared with LASIK.

What Dryness Feels Like After PRK

Dryness after PRK is normal and expected, but it usually affects people differently than LASIK.

Typical symptoms include:

• Mild dryness during the first few weeks
• Occasional burning
• Fluctuating vision
• Light sensitivity
• Blinking discomfort during the healing phase

These symptoms tend to improve steadily as the surface heals.

The dryness timeline:

• Week 1: Mild to moderate dryness as the epithelium heals
• Weeks 2–6: Tear film becomes more stable
• Months 3–6: Most dryness has reduced significantly

People with pre-existing dry eyes usually adapt better to PRK than LASIK because the healing feels more natural and less nerve-disruptive.

Why PRK Doesn’t Cause Long-Term Dry Eyes the Same Way LASIK Can

Corneal nerves take time to regenerate. The more nerves are affected, the more dryness you may experience.

LASIK nerve disruption:

Deep nerves are cut during flap creation.

PRK nerve disruption:

Only surface nerves are temporarily affected.

This fundamental anatomical difference is why PRK is recommended for anyone with:

• Chronic dry eyes
• Contact lens intolerance
• Autoimmune-related dryness
• Mild tear-film dysfunction

Who Makes a Good Candidate for PRK if You Have Dry Eyes?

PRK may be suitable for you if:

• You have mild to moderate dryness
• Your corneal thickness is borderline for LASIK
• Your tear breakup time (TBUT) is low
• You experience discomfort with lenses
• You work in dusty or high-impact environments
• You want the safest long-term outcome for your tear film

Your suitability still depends on a detailed assessment, but PRK opens doors that LASIK closes for many people.

Dry Eye Tests Your Surgeon Will Perform Before PRK

To make sure PRK is safe for you, your ophthalmologist will run several diagnostic tests.

Schirmer’s Test

Measures tear production.

TBUT (Tear Break-Up Time)

Checks how quickly tears evaporate.

Osmolarity Test

Evaluates tear-film stability.

InflammaDry Test

Checks for inflammatory markers (MMP-9).

Meibomian Gland Dysfunction (MGD) Assessment

Identifies blockages in oil glands.

Corneal Topography

Ensures your cornea is healthy and regular.

These tests help create a plan that supports your eyes both before and after surgery.

Preparing Your Eyes Before PRK

If you already have dryness, you may need a pre-treatment plan to optimise your eyes.

This may include:

• Lubricating eye drops
• Omega-3 supplements
• Warm compresses
• Meibomian gland therapy (LipiFlow or IPL)
• Anti-inflammatory drops
• Punctal plugs to retain moisture
• Eyelid hygiene routines

Pre-conditioning helps stabilise your tear film and ensures a smoother recovery.

PRK Recovery for Dry Eyes: What to Expect

PRK recovery is slower than LASIK, but many people appreciate the stability it brings long-term.

Stage 1: First 3–5 Days

• Discomfort
• Blurry vision
• Light sensitivity
• A bandage lens on your eye

Dryness is common, but artificial tears help significantly.

Stage 2: Weeks 2–4

• Surface continues to smooth
• Vision fluctuates
• Dryness gradually improves
• Eye drops are still needed

Stage 3: Months 2–6

• Laser clarity becomes stable
• Dryness reduces significantly
• Corneal nerves regenerate naturally

By this point, most patients say their eyes feel either the same as before surgery or better.

Managing Dryness After PRK

Your surgeon will give you a personalised aftercare plan, but common strategies include:

Preservative-free artificial tears

Use frequently during the first few months.

Punctal plugs

These tiny inserts reduce tear drainage and help retain moisture.

Warm compresses

Support oil production to prevent tear evaporation.

Omega-3 supplements

Help improve the quality of your tear film.

Humidifier use

Especially helpful during winter or prolonged screen time.

Avoiding air-conditioning and wind exposure

To prevent rapid tear evaporation.

Limiting screen time initially

Screens reduce blink rate and worsen dryness.

Can PRK Solve Dry Eyes?

PRK doesn’t cure dry eyes, but it often becomes the safest option if you already struggle with dryness. Many patients report:

• More stable vision
• Fewer symptoms compared to contact lenses
• Lower irritation risk than LASIK
• Less worry about flap complications

As long as the dryness is mild to moderate and treated properly, PRK can give long-term comfort and better visual clarity.

Special Considerations for Severe Dry Eyes

If your dryness is severe, persistent or associated with autoimmune conditions like Sjögren’s syndrome, your surgeon may recommend:

• Ocular surface therapy
• Punctal occlusion
• Autologous serum eye drops
• Advanced meibomian gland treatments

In some cases:

PRK may still be possible once the tear film improves.

In rare cases:

Laser surgery might not be appropriate until dryness is stabilised.

PRK vs LASIK for Dry Eyes: Comparison Chart

Flap creation:
PRK does not involve creating a corneal flap, while LASIK requires a flap to be created. Because LASIK disrupts more corneal nerves during flap creation, it can increase the risk of dry eyes after surgery.

Dry eye impact:
PRK generally has a lower impact on dry eyes, making it more suitable for people who already experience dryness. LASIK, on the other hand, has a higher tendency to worsen dryness, especially in the early healing period.

Recovery time:
PRK has a slower recovery time because the surface layer of the cornea needs to regenerate. LASIK offers a much faster recovery, often with clearer vision within a day or two.

Corneal stability:
PRK provides higher corneal stability in the long term since there is no flap. LASIK offers good stability too, but it is slightly lower due to the presence of the flap.

Suitability for thin corneas:
PRK is an excellent option for people with thin corneas. LASIK may not be suitable in such cases because it requires more corneal tissue.

Suitability for contact lens intolerance:
PRK is often recommended for those who cannot tolerate contact lenses. LASIK may be suitable in some cases but not always ideal for patients with severe intolerance.

Long-term dryness risk:
PRK carries a lower long-term risk of dryness, whereas LASIK has a higher chance of dryness persisting, especially in patients who already have dry eyes before surgery.

FAQs:

1. Is PRK really safer than LASIK for people with dry eyes?
   Yes, PRK is generally considered safer because it does not involve creating a corneal flap. During LASIK, nerves responsible for tear production are cut, which can reduce tear reflex and make dryness worse. PRK only affects the surface layer of the cornea, meaning far fewer nerves are disrupted. As a result, people with pre-existing dry eyes usually experience a gentler healing process and a lower risk of long-term dryness compared to LASIK.
2. Will PRK make my dry eyes worse permanently?
   Most people do not experience permanent worsening of dry eyes after PRK. It can cause temporary dryness during the healing period, especially in the first few weeks, but the symptoms typically improve steadily as the corneal surface regenerates. Because the deeper nerves remain untouched, the tear film often becomes more stable with time. Long-term dryness is uncommon, especially when proper aftercare and tear-film treatment are followed.
3. How long does dryness last after PRK?
   Dryness usually peaks in the first week as the epithelium heals, and then gradually improves over the next several weeks. Most people notice significant relief between two to six weeks, and by three to six months, the majority report that their eyes feel either the same as before surgery or noticeably better. The timeline can vary depending on your tear quality, lifestyle, and how consistently you follow your aftercare plan.
4. Can PRK cure my dry eyes completely?
   PRK is not designed to cure dry eye syndrome, but it can allow you to enjoy vision correction without worsening your symptoms. Some patients even feel more comfortable after surgery because they are no longer wearing contact lenses, which often aggravate dryness. The main goal of PRK is to avoid additional nerve damage, making it a safer choice for people who already struggle with dryness.
5. If I have severe dry eyes, can I still get PRK?
   Severe dry eyes require a careful evaluation before surgery. Many people with significant dryness can still have PRK once their tear film is stabilised with treatments like lubricating drops, punctal plugs, omega-3 supplements, or meibomian gland therapy. However, if the dryness is uncontrolled or linked to an autoimmune condition, your surgeon may recommend improving the ocular surface first or, in rare cases, avoiding laser surgery until the condition is better managed.
6. How does PRK affect the tear film during recovery?
   Immediately after PRK, the tear film is slightly unstable because the surface layer of the cornea is healing. This can create fluctuations in clarity, a gritty sensation, or occasional burning. As the epithelium regenerates, the tears spread more evenly across the cornea and the stability gradually returns. Since the procedure does not cut the deeper nerves, the tear film typically recovers more naturally and completely compared with LASIK.
7. Can I use artificial tears after PRK if my eyes are already dry?
   Absolutely, and in fact, it’s recommended. Preservative-free artificial tears are a key part of recovery because they help keep the surface moist and reduce discomfort. Using them regularly during the first few months keeps the tear film stable, speeds healing, and prevents irritation. Your doctor may also suggest additional therapies such as punctal plugs or warm compresses if dryness is more persistent.
8. Will screen time make dryness worse after PRK?
   Yes, screen time can temporarily make dryness worse because it reduces your blink rate. After PRK, the eyes are more sensitive, and prolonged screen use may lead to faster tear evaporation. It’s best to take frequent breaks, follow the 20-20-20 rule, and use lubricating drops whenever your eyes feel strained. As healing progresses, most people find they can return to normal screen habits comfortably.
9. Is PRK painful for people with dry eyes?
   The procedure itself is usually painless, but the first few days of recovery can feel more noticeable if you already have dryness. Some people describe it as a gritty, burning, or sandy sensation. These symptoms are managed with numbing drops, bandage contact lenses, lubricants, and medications provided by your surgeon. The discomfort generally improves significantly once the epithelium has healed.
10. How do I know if PRK is the right choice for my dry eyes?
    The best way to determine suitability is through a detailed assessment that includes tear-film testing, corneal mapping, and an evaluation of your meibomian glands. If your dryness is mild to moderate and your corneal thickness is suitable, PRK is often the preferred option. If your dryness is more severe, pre-treatment may be needed to stabilise the ocular surface first. Your individual lifestyle, visual goals, and tear-film health all help determine whether PRK will give you safe, comfortable, long-term results.

Final Thoughts: Choosing the Safest Laser Option for Dry Eyes

Living with dry eyes can make the decision about laser vision correction feel overwhelming, but PRK often provides a safer and more comfortable pathway for long-term clarity. Because it avoids flap creation and disrupts fewer corneal nerves, PRK tends to offer more stability and less dryness for those already struggling with tear-film issues. With the right assessment, pre-treatment, and aftercare, many patients with mild to moderate dryness achieve excellent visual results without worsening their symptoms. If you’re considering PRK surgery in London and want to know if it’s the right option for your eyes, you’re welcome to reach out to us at Eye Clinic London to book a consultation.

References:

1. Bower, K.S., Sia, R.K., Ryan, D.S., Mines, M.J. & Dartt, D.A. (2015) ‘Chronic dry eye in photorefractive keratectomy and laser in situ keratomileusis: manifestations, incidence, and predictive factors’, Journal of Cataract & Refractive Surgery, 41(12), pp. 2624–2634. https://pubmed.ncbi.nlm.nih.gov/26796443/
2. Yahalomi, T., Spiegel, D., May, M., Nir-Cohen, G., Zadok, D., Levkovitch,-Verbin, H., Avni, I. & Varssano, D. (2023) ‘Dry eye disease following LASIK, PRK, and LASEK: an observational cross-sectional study’, Journal of Clinical Medicine, 12(11), 3761. https://www.mdpi.com/2077-0383/12/11/3761
3. Zarei-Ghanavati, S., et al. (2025) ‘Dry eye after photorefractive keratectomy (PRK) and transepithelial photorefractive keratectomy: a comparative clinical study’, BMC Ophthalmology. https://pubmed.ncbi.nlm.nih.gov/40540100/
4. Way, C. & Rüden, D.von (2024) ‘Transepithelial Photorefractive Keratectomy Review’, Vision, 8(1), 16. https://www.mdpi.com/2411-5150/8/1/16
5. Bower, K.S., Sia, R.K., Ryan, D.S., Mines, M.J. & Dartt, D.A. (2015) ‘Chronic dry eye in PRK and LASIK: manifestations, incidence and predictive factors’, Journal of Cataract & Refractive Surgery, 41(12), pp. https://pmc.ncbi.nlm.nih.gov/articles/PMC5702539/