A patient from Santa Maria recently asked me about dry eye and LASIK. Many patients have difficulty with their contact lenses due to underlying dry eye and look to LASIK as an alternative to contacts. To optimize the results of LASIK, it is helpful to treat dry eye before undergoing LASIK or PRK laser eye surgery. While we currently have many highly effective therapies for treating dry eye before LASIK, there is a very interesting new school of thought emerging about a potential major cause of dry eyes that I wanted to talk about in this blog. There is increasing evidence pointing to the role of biofilms as an underlying cause of dry eye. Biofilms are debris created by bacteria that, in turn, provide a scaffold for bacteria to multiply on. Many people have excess counts of bacteria on their eye lids and eye lashes due to underlying problems with the type of oil in their skin (these oil problems can have both a genetic or nutritional basis). This is particularly true for patients with acne rosacea, but can occur even in people without this particular skin condition. These excess bacteria use the biofilm to multiple and create destructive inflammation and ultimately dry eye. Blepharitis, a commonly recognized inflammatory eyelid condition, is the classic example of this process. In the future, specific drugs likely will target this biofilm and take away the foundation that the bacteria are using to cause dry eye. In the meantime, there currently are very effective new antibiotic drops such as Azasite or antibiotic eye wipes such as Avenova Wipes that can dramatically reduce bacterial counts. These approaches do not target the biofilm, but they can be quite effective because they still result in lower bacterial counts. We have successfully treated many dry eye patients who could no longer wear contact lenses comfortably to the point that they could enjoy a contact-lens free life with LASIK or PRK. Careful attention to addressing underlying dry eye problems before surgery is an important tool to achieving the best possible post-operative results after LASIK or PRK. It is important to note, of course, that these underlying dry eye problems may require ongoing treatment whether or not the patient has LASIK or PRK.