Laser in situ keratomileusis-induced (presumed) neurotrophic epitheliopathy

Ophthalmology. 2001 Jun;108(6):1082-7. doi: 10.1016/s0161-6420(01)00587-5.


Objective: To evaluate tear production, corneal topography, accuracy of refractive correction, and best spectacle-corrected visual acuity in eyes that had moderate to severe rose bengal staining develop on the flap compared with eyes with little or no staining on the flap, the first few months after laser in situ keratomileusis (LASIK). None of the eyes in this study had significant preoperative dry eye disease.

Design: Retrospective case control study.

Participants: Individual eyes of 19 consecutive patients with moderate to severe punctate epithelial erosions and rose bengal staining on the flap 1 to 3 months after LASIK were compared with eyes of 19 concurrent patients who did not have punctate epithelial erosions or more than trace staining on the flap develop.

Methods: Nonparametric statistical analyses were used to compare tear secretion, corneal topographic irregularity, spherical equivalent, and visual acuity 3 and 6 months after surgery. Some eyes in both groups also had analysis of tear secretion 1 month after surgery.

Main outcome measures: Schirmer's test without anesthesia, the topographic corneal irregularity measurement (CIM), the difference between attempted and achieved spherical equivalent, and the loss of best spectacle-corrected visual acuity.

Results: There was no difference in tear production 1, 3, or 6 months after LASIK in patients who had punctate epithelial erosions and rose bengal staining on the flap develop and those who did not. There was no significant difference in the CIM or mean accuracy of the refractive correction in the two groups, but some patients had a transient decrease in best spectacle-corrected visual acuity. Flap rose bengal staining resolved by 6 months after LASIK in most affected patients.

Conclusions: LASIK-induced rose bengal staining in patients without preexisting dry eye is likely neurotrophic epitheliopathy, because there is no difference in mean tear production between patients who have significant punctate epithelial erosions and rose bengal staining develop on the flap and those who do not. The signs and symptoms of LASIK-induced (presumed) neurotrophic epitheliopathy tend to resolve approximately 6 months after surgery. This disorder tends to be more common and severe in patients with pre-existing dry eye disease.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Cornea / innervation*
  • Corneal Diseases / etiology*
  • Corneal Diseases / metabolism
  • Corneal Topography
  • Cranial Nerve Diseases / etiology*
  • Cranial Nerve Diseases / metabolism
  • Endothelium, Corneal / metabolism
  • Epithelium, Corneal / metabolism
  • Epithelium, Corneal / pathology*
  • Humans
  • Keratomileusis, Laser In Situ / adverse effects*
  • Myopia / surgery
  • Ophthalmic Nerve / metabolism
  • Ophthalmic Nerve / pathology*
  • Refraction, Ocular
  • Retrospective Studies
  • Rose Bengal
  • Tears / metabolism
  • Visual Acuity


  • Rose Bengal