LASIK Flap Wrinkle?

A LASIK flap wrinkle, also known as striae, is a rare complication that occurs when the corneal flap created during LASIK surgery is not perfectly smooth after it is repositioned.

These wrinkles can interfere with vision clarity and may require immediate attention depending on their severity.

Understanding the LASIK Procedure

LASIK surgery is one of the most popular laser eye correction procedures. It involves creating a thin flap on the cornea’s surface, reshaping the underlying tissue with a laser, and repositioning the flap to allow the eye to heal naturally. Any irregularities during the healing process, like the formation of wrinkles in the flap, can lead to post-surgery complications.

What is a LASIK Flap Wrinkle?

A LASIK flap wrinkle refers to creases or folds that develop in the corneal flap either during or after the LASIK procedure. This can happen due to improper realignment of the flap, physical trauma to the eye shortly after surgery, or even rubbing the eyes during the critical healing period. Flap wrinkles typically occur within the first few days or weeks after surgery, but in rare cases, trauma can induce them months or even years later.

Wrinkles in the flap disrupt the smooth surface required for optimal vision, leading to symptoms like blurred or distorted vision.

There are two types of flap wrinkles: microstriae, which are fine and may not affect vision, and macrostriae, which are larger folds that can distort vision and often require treatment.

Key takeaway: While rare, LASIK flap wrinkles can significantly affect the surgery’s success and your overall satisfaction with the results.

Causes of LASIK Flap Wrinkles

Flap Creation

Errors during flap creation—such as an uneven thickness or irregular shape—can increase the risk of flap misalignment during repositioning, which may lead to the formation of wrinkles (striae).

Fact Check: Flap wrinkles are more commonly associated with microkeratome-based flap creation, used in older techniques. Modern femtosecond lasers allow for more consistent flap thickness and positioning, significantly reducing this risk.

Eye Trauma Post-Procedure

The healing eye is extremely vulnerable in the weeks following LASIK surgery. Physical trauma caused by rubbing your eyes, sleeping on your face, or even accidental bumps can lead to flap misalignment and wrinkling.

Dry Eye Syndrome

Dry eyes are a common side effect of LASIK and can interfere with optimal healing conditions, though they are not a direct cause of flap wrinkles. Poor lubrication may hinder flap adherence and increase the chance of complications if left untreated.

Patient Noncompliance

Ignoring post-surgery guidelines, such as failing to wear protective eye shields or not using prescribed lubricating drops, can disturb the flap. Patient care post-surgery is crucial to prevent complications like flap wrinkles.

Symptoms to Watch For

Blurred Vision

A common symptom of a LASIK flap wrinkle is persistent blurry or hazy vision that does not improve over time or with standard visual correction.

Ghosting or Monocular Double Vision

Some patients report seeing double or overlapping images in one eye, commonly referred to as ghosting. This differs from true binocular double vision, which involves both eyes and is less likely to be caused by flap wrinkles.

Light Sensitivity

Flap wrinkles can increase sensitivity to light and glare (photophobia), especially in the presence of visual distortions.

Discomfort

While not always painful, flap wrinkles may cause a gritty sensation, foreign body feeling, or mild irritation in the affected eye.

Take action if you notice any unexplained symptoms after LASIK. Consult your surgeon immediately to rule out complications like flap wrinkles.

Diagnosis of LASIK Flap Wrinkles

Slit-Lamp Examination

Ophthalmologists use a slit-lamp biomicroscope with high magnification and special lighting to examine the corneal flap. This allows detection of microstriae or macrostriae that may not be apparent during a routine eye exam.

Topography

Corneal topography creates a detailed map of the corneal curvature, revealing surface irregularities caused by flap striae. It’s especially useful for correlating visual symptoms with topographic distortions.

Diagnosis Tip: If you experience vision problems or discomfort post-LASIK, schedule an eye examination promptly to ensure early detection and treatment.

Treatment of LASIK Flap Wrinkles

Flap Repositioning

For mild cases, the surgeon can lift and reposition the flap to smooth out the wrinkles. This relatively straightforward procedure is often sufficient to restore clear vision.

Surgical Intervention

In more severe cases, the surgeon may first lift and reposition the flap to smooth out macrostriae. If visual distortion persists due to residual irregularities, additional treatments such as phototherapeutic keratectomy (PTK) or stromal puncture/hydration may be considered to improve corneal surface regularity.

Post-Treatment Care

Following treatment, patients are typically advised to follow strict aftercare protocols to promote healing and reduce the risk of recurrence.

Tip for Recovery: Increased use of lubricating eye drops can help during recovery and minimise discomfort.

How to Prevent LASIK Flap Wrinkles?

Choose an Experienced Surgeon: An experienced and skilled LASIK surgeon significantly reduces the risk of complications. Ensure your surgeon has a proven track record.
Adhere to Post-Surgery Care: Follow your surgeon’s instructions carefully. This includes wearing protective eye shields, using prescribed eye drops, and avoiding physical activities that could strain your eyes.
Avoid Rubbing Your Eyes: This cannot be overstated. Rubbing the eyes is one of the leading causes of flap wrinkles, particularly during the first few weeks following surgery.
Keep Your Eyes Moisturised: Use lubricating eye drops as prescribed to keep your eyes from drying out, which can interfere with proper healing.
Regular Follow-Ups: Attend all your post-surgery check-ups to ensure everything is healing properly and to address any concerns early.

Risk Factors for LASIK Flap Wrinkles

Thin Corneal Tissue: Individuals with thin corneas are at higher risk of flap complications during LASIK.
High Refractive Error: Correcting high levels of myopia or hyperopia often requires deeper stromal ablation, which can reduce residual stromal thickness and increase the risk of flap striae or instability.
Pre-Existing Eye Conditions: Dry eye syndrome, corneal irregularities, or previous ocular surgeries can increase the likelihood of flap wrinkles.
Age Extremes: Both very young and elderly patients may have corneal biomechanical differences or slower healing responses, which could slightly increase the risk of flap-related complications.

When to Seek Professional Help?

Contact your ophthalmologist immediately if you experience any of the following post-surgery symptoms:

Persistent blurry or distorted vision
Worsening light sensitivity
Pain or discomfort that doesn’t improve
Any new or unusual symptoms

Prompt treatment is essential for effective resolution and to ensure your vision is not permanently affected.