Post-refractive Surgery Trauma

Refractive surgery aims to alter the refractive state of the eye by means of various surgical techniques. In the human eye, the cornea accounts for approximately two-thirds of the eye’s total optical/refracting power, while the crystalline lens accounts for the remaining one-third. Refractive surgery utilizes different modalities to modify the refractive power of the cornea, thereby correcting the refractive state of the eye, such as myopia, hyperopia, astigmatism, and presbyopia. All of these procedures are either incisional, lamellar, photoablative laser, or intrastromal, and they all inherently weaken the native cornea. This inherent weakness may be exposed when the eye suffers a traumatic injury. In patients with trauma, diagnosis and treatment of life-threatening injuries takes precedence over ophthalmic trauma. While a careful history regarding the nature of the inciting injury is important, even mild or benign appearing trauma may be more damaging in a post-refractive eye. Because of this, one must be more prepared to identify traumatic ophthalmic injuries in this population. In this chapter, we describe various types of refractive surgical procedures that one might encounter in an office, urgent care, and emergency room setting. We describe the types of traumatic injuries that each procedure would lend itself to as well as the management of such traumatic injuries.