LASIK Eye Surgery: What to Expect Before, During, and After the Procedure

LASIK is one of the most commonly performed elective surgical procedures in the world, with an excellent safety record and high patient satisfaction rates. Despite this, many patients arrive at their procedure with incomplete information about what the experience actually involves, what they will feel during and after the surgery, and what to expect during recovery. This guide explains the complete LASIK experience from preparation through recovery, including the postoperative drops, vision timeline, time off work, and the risks that need to be understood before proceeding.

Before the procedure: preparation and what to bring

On the day of your LASIK procedure, several preparations are important before you arrive at the laser surgical centre.

Contact lenses must be removed in advance. Soft contact lenses should be removed at least one week before your assessment and procedure. Rigid gas permeable lenses require a longer period out, typically three to four weeks, because they temporarily reshape the cornea and your topography must reflect your natural corneal shape for accurate laser treatment planning. If you are still wearing contact lenses on the day of your assessment or procedure, the measurements and the laser treatment will be inaccurate.

Eye makeup, creams, and perfumes must not be worn on the day of surgery. Residue from cosmetics and skincare products around the eyes can contaminate the sterile field and increases the risk of infection. Arrive with clean skin around the eyes and no fragrance.

Arrange transport home. You cannot drive after LASIK. The anaesthetic drops will affect your vision and you will be asked to rest with your eyes closed for at least two to four hours after the procedure. Bring someone to drive you, or arrange a taxi.

A light meal beforehand is appropriate. You do not need to fast for LASIK. Anxiety on an empty stomach is uncomfortable.

What happens at the laser surgical centre

LASIK is performed at a dedicated laser surgical centre, not in a standard operating theatre. The procedure room contains the excimer laser system and the microkeratome or femtosecond laser used to create the corneal flap. You will be asked to change into a surgical gown and your eyes will be cleaned with antiseptic solution around the lids and lashes to reduce the risk of infection. This is an important infection-control step and not merely cosmetic preparation.

Antibiotic eye drops are instilled before the procedure begins. These begin reducing the bacterial load on the ocular surface before the flap is created and the laser is applied to the exposed stromal bed.

Topical anaesthetic drops are then applied. LASIK is performed entirely under topical anaesthesia. You will be awake throughout the procedure. No injection is given around or into the eye. The anaesthetic drops numb the surface of the eye completely, so the procedure is painless. Most patients are surprised by how comfortable the experience is.

You will be asked to lie flat under the laser system and to focus on a small blinking light. A speculum is placed to hold the eyelids open. This can feel slightly unusual but is not painful. The femtosecond laser then creates the corneal flap, which takes approximately 20 to 30 seconds per eye. You may notice your vision go dark briefly during this step as the suction ring is applied. This is normal and temporary.

The flap is then lifted and folded back. The excimer laser is applied to the stromal bed for a period that depends on your prescription, typically 20 to 60 seconds per eye. You may notice a faint smell during this phase, which is the laser ablating corneal tissue. The flap is then repositioned and smoothed flat. The entire procedure for both eyes typically takes 10 to 15 minutes.

Immediately after the procedure

Your vision will be blurred immediately after the procedure. This is expected. Antibiotic and anti-inflammatory eye drops are instilled before you leave the laser centre. You will be given a complete postoperative drop regimen to take home.

Most patients experience some light sensitivity, mild discomfort, and a watery or gritty sensation in the first few hours after LASIK. These symptoms are caused by the disruption of the corneal surface nerves by the flap and resolve within the first day in the majority of patients. You will be asked to rest with your eyes closed for at least two to four hours after the procedure, ideally sleeping if possible, as this is the period of greatest discomfort.

You must not rub your eyes at any point after LASIK, particularly in the first month. The flap does not heal to the surrounding cornea in the same way as a normal wound. Rubbing can displace the flap in the early postoperative period, requiring repositioning. If your eyes feel irritated, use lubricating drops rather than rubbing.

Protective eye shields are worn overnight for the first one to two weeks to prevent inadvertent rubbing while asleep.

Postoperative eye drops

The postoperative drop regimen after LASIK serves two purposes: preventing infection and reducing inflammation to promote healing and visual recovery.

Antibiotic drops are used four times daily for the first week. These reduce the risk of infectious keratitis, a rare but serious complication. Do not skip antibiotic doses during the first week even if your eye feels comfortable.

Steroid drops are used in a tapering course over four to six weeks. The steroid reduces the inflammatory response in the cornea following laser treatment. The taper is important: reducing the steroid too quickly can cause a rebound inflammatory response that may affect the refractive outcome. Follow the tapering schedule provided.

Lubricating drops without preservatives are used frequently throughout the day, particularly in the first three months. LASIK reduces corneal sensitivity and tear production in the early postoperative period by disrupting the superficial corneal nerves. This produces a temporary dry eye state that resolves as the nerves regenerate over three to six months. Dry eye symptoms are the most common complaint after LASIK and are managed with frequent lubrication.

Vision recovery timeline

Vision recovery after LASIK is faster than after any other corneal refractive procedure. Most patients achieve functional driving vision within 24 hours of surgery. Approximately 96 percent of patients achieve uncorrected distance visual acuity of 6/6 (20/20) or better at three months. For published outcomes data on LASIK and other refractive procedures, see the LASIK and PRK outcomes data guide.

Day one: most patients notice significantly improved vision, often achieving 6/6 (20/20) or close to it. Some fluctuation, haze, and haloes around lights are normal on day one.

Week one: vision continues to improve and stabilise. Dryness and mild fluctuation are common. Most patients can return to office-based work within two to four days.

One to three months: vision stabilises progressively. Haloes and glare around lights, particularly at night, are common in the first one to three months as the corneal healing response continues. These typically resolve as the cornea settles.

Three to six months: final refraction is stable and dry eye symptoms resolve as corneal nerve density returns. Some patients require lubricating drops for up to twelve months.

Time off work and activity restrictions

LASIK allows one of the fastest returns to normal activity of any refractive procedure.

Work: most patients return to office-based or sedentary work within two to four days. Screen use is restricted in the first 24 to 48 hours due to reduced blink rate worsening dry eye symptoms. Gradual return to screen use over the first week is advised.

Driving: you must not drive on the day of surgery. Most patients can drive the following day if their visual acuity meets the legal driving standard, which is confirmed at the day one review.

Exercise: light exercise such as walking can be resumed within a few days. Contact sports, swimming, and activities with a high risk of eye trauma or water contamination should be avoided for at least four weeks. Swimming in pools, ocean, and spas should be avoided for four weeks due to infection risk.

Eye makeup: avoid for at least one week. Mascara and eyeliner increase infection risk and can irritate the healing flap edge.

Risks and what to watch for

LASIK has an excellent safety profile in appropriately selected patients. The most common side effects are temporary and include dry eye, haloes, glare, and mild undercorrection or overcorrection in a small proportion of patients requiring enhancement.

Serious complications are uncommon but include:

Flap complications: flap displacement can occur in the early postoperative period, particularly from eye rubbing or trauma. If you notice sudden blurring after rubbing or trauma, contact your surgeon immediately. Flap repositioning is usually straightforward if performed promptly. The incidence of flap dislocation requiring repositioning is approximately 0.35 percent in femtosecond LASIK.

Dry eye: approximately 30 percent of patients experience new dry eye symptoms in the first three months after LASIK. For the majority these resolve with lubrication. A small proportion of patients with pre-existing severe dry eye may experience prolonged symptoms. Dry eye is the primary reason that a thorough pre-operative assessment of the ocular surface is essential before proceeding with LASIK.

Infection: infectious keratitis after LASIK is rare with an incidence of approximately 0.02 percent in published series. Presenting symptoms are increasing pain, redness, and blurred vision in the first one to two weeks. This requires urgent assessment and treatment.

Ectasia: laser vision correction in eyes with subclinical corneal ectasia or insufficient residual stromal bed thickness can rarely trigger progressive corneal thinning (ectasia). This is the most serious potential long-term complication of LASIK and is prevented by rigorous pre-operative screening including corneal topography, tomography, and pachymetry. This is why corneal assessment before surgery is mandatory and not negotiable.

When to seek urgent review: increasing pain, sudden vision loss, increasing redness, purulent discharge, or any sudden change in vision in the postoperative period requires same-day contact with your surgeon or an emergency eye department.

If you are considering an alternative to LASIK, see the guide to PRK: what to expect. For patients also considering cataract surgery or refractive lens exchange, a separate consultation is required. Referrals and bookings can be made through Dr Ross MacIntyre at Northern Eye Consultants.

References

1. 1.Moshirfar M, et al. A Toolkit for Patients Evaluating Benefits and Risks of LASIK. Expert Rev Ophthalmol. 2024.
2. 2.Randleman JB, et al. Incidence, Risk, and Visual Outcomes after Repositioning of Acute Non-Traumatic Flap Dislocations Following Femtosecond-Assisted LASIK. PMC8199895.
3. 3.American Refractive Surgery Council. LASIK Clinical Research.