Contact lenses, dry eyes and laser eye surgery

Many people who consider laser eye surgery are long-term contact lens wearers. Contact lenses are a convenient way to correct vision, but they can also affect the surface of the eye. If you are thinking about LASIK, SMILE or LASEK, it is important to understand how contact lens wear and dry eye interact with the assessment and the surgery itself.

Why contact lenses matter before laser eye surgery

Contact lenses sit on the cornea, the clear window at the front of the eye. They can temporarily alter the shape of the cornea, especially rigid gas-permeable lenses, and they can affect the tear film. For accurate measurements before laser eye surgery, we need the cornea to be in its natural state. This means stopping contact lens wear before the assessment.

Soft lenses should usually be stopped for at least three to seven days before measurements. Toric soft lenses, which are weighted to correct astigmatism, may need a longer break. Rigid gas-permeable lenses can change the cornea more significantly, and we often ask patients to stop wearing them for several weeks, sometimes longer, depending on how long they have been worn and how stable the cornea is.

Dry eye is common in contact lens wearers

Contact lenses reduce the amount of oxygen reaching the cornea and can disrupt the tear film. Over time, this can lead to or worsen dry eye symptoms such as grittiness, burning, redness, fluctuating vision and discomfort. Many people do not realise their eyes are dry because they have become used to the feeling, but the signs are usually picked up during a laser assessment.

Dry eye is also one of the most common side effects after laser eye surgery. If your eyes are already dry before surgery, the symptoms may be more noticeable afterwards. For this reason, we usually treat dry eye before scheduling surgery, not after.

What happens at the assessment

During a laser eye surgery assessment, we measure the corneal shape and thickness, check the tear film, and look for signs of dry eye or inflammation. Tests may include corneal topography, tear break-up time, and sometimes staining of the eye surface to look for damage. We also ask about your contact lens history, including the type of lenses, how many hours you wear them, and whether you have had discomfort or infections.

If the cornea has been temporarily reshaped by contact lenses, the measurements will not be reliable. If we operate based on inaccurate measurements, the result will be less predictable. This is why stopping lenses before the assessment is essential.

Treating dry eye before surgery

If dry eye is found before surgery, we usually start treatment to improve the tear film. This may include lubricating eye drops, warm compresses, lid hygiene, omega-3 supplements, or prescription anti-inflammatory drops. In some cases, we recommend punctal plugs to reduce tear drainage. The goal is to get the surface of the eye healthy and stable before the laser treatment.

Most patients find that their dry eye improves significantly once they stop wearing contact lenses and start treatment. This also gives us a clearer picture of whether laser eye surgery is suitable.

Does dry eye rule out laser eye surgery?

Not always. Mild to moderate dry eye can usually be treated successfully before surgery. However, severe dry eye, recurrent contact lens intolerance, or certain conditions such as Sjögren's syndrome or significant meibomian gland dysfunction may make laser surgery less suitable. In these cases, alternatives such as implantable collamer lenses (ICLs) or refractive lens exchange may be safer options.

The important point is that dry eye should be identified and treated before surgery, not ignored. Good pre-operative care reduces the risk of post-operative problems and helps you recover faster.

What to expect after surgery

After laser eye surgery, almost everyone experiences some degree of dry eye in the first few weeks and months. This is because the corneal nerves are temporarily affected by the laser. For most people, this settles as the nerves recover. If you had dry eye before surgery, your symptoms may take longer to settle, but they usually improve compared with contact lens wear over time.

We continue lubricating drops and sometimes other dry eye treatments after surgery to keep the surface comfortable and promote healing. Attending follow-up appointments is important so we can adjust treatment if needed.

Next steps

If you wear contact lenses and are considering laser eye surgery, the first step is to stop wearing your lenses and book a comprehensive assessment. Bring details of the lenses you wear and any history of dry eye or discomfort. We will examine the cornea and tear film, explain whether your eyes are ready for surgery, and discuss the best treatment approach for you.