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

Photorefractive keratectomy (PRK) is a surface laser refractive procedure that achieves the same visual outcome as LASIK but uses a different technique that avoids creating a corneal flap. PRK is preferred over LASIK for patients with thin corneas, irregular corneal topography, dry eye, or occupations or activities where a corneal flap would present a risk. The trade-off is a longer and more uncomfortable recovery period than LASIK. This guide explains the complete PRK experience including what happens during the procedure, how pain is managed, the postoperative drop regimen, the role of mitomycin-C in preventing corneal haze, and the realistic vision recovery timeline.

How PRK differs from LASIK

In LASIK: what to expect, a thin corneal flap is created before the laser is applied to the stromal bed, and the flap is then replaced to act as a natural bandage. In PRK, there is no flap. The corneal epithelium, the protective surface layer of cells covering the cornea, is removed entirely before the laser is applied to the exposed corneal stroma. After the laser treatment, the epithelium regenerates over three to five days while a bandage contact lens protects the surface.

The absence of a flap is PRK's primary advantage in specific clinical situations. Eyes with insufficient corneal thickness for safe LASIK, corneas with topographic irregularity suggesting subclinical ectasia risk, and eyes with severe dry eye are all better served by PRK. For military personnel, contact sports athletes, and others at risk of blunt eye trauma, PRK is preferred because there is no flap to displace. PRK is also used for corneal surface regularisation in patients with keratoconus and when PRK is appropriate following stabilisation with crosslinking.

The primary disadvantage of PRK is the recovery period. The epithelial healing phase of three to five days is associated with significant discomfort, and visual recovery to functional acuity takes one to two weeks rather than the 24 hours typical of LASIK.

Before the procedure: preparation

The preparation for PRK is the same as for LASIK. Contact lenses must be removed in advance, soft lenses for at least one week and rigid lenses for three to four weeks. No eye makeup, creams, or perfumes on the day of surgery. Arrange transport home as you will not be able to drive after the procedure.

On the day of the procedure, antibiotic drops are instilled before surgery begins as part of infection prevention. The skin around the eyes is cleaned with antiseptic solution. You will be awake throughout the procedure under topical anaesthesia.

What happens during PRK

PRK is performed at a laser surgical centre under topical anaesthetic drops. You will be awake and asked to fixate on a target light. No injection is required. The procedure itself is painless under the topical anaesthetic.

The epithelium is removed from the central cornea. This is done using a blunt spatula after the application of dilute alcohol solution to loosen the surface cells, or mechanically using a rotating brush. The epithelial removal takes approximately 30 seconds and you will not feel it under the anaesthetic.

The excimer laser is then applied directly to the stromal bed. The laser treatment takes 20 to 60 seconds per eye depending on the prescription. The total procedure time for both eyes is typically 10 to 15 minutes.

Transepithelial PRK: a single-step alternative

Transepithelial PRK (t-PRK), also called single-step PRK or StreamLight PRK on the WaveLight EX500 platform, is a variation of PRK in which the excimer laser removes the epithelium and performs the stromal ablation in a single continuous step. No alcohol solution, no blunt spatula, and no manual epithelial debridement is involved. The entire procedure from the first laser pulse to the last is performed by the laser system.

In conventional PRK, the epithelium is removed first using alcohol or mechanical debridement, and the excimer laser then treats the exposed stroma. In t-PRK, the laser system uses a pre-programmed epithelial removal profile based on published corneal epithelial thickness maps, typically 55 microns centrally graduating to 65 microns at the periphery, followed immediately by the refractive ablation profile, all in one sequence.

The theoretical advantages of t-PRK over conventional PRK are reduced tissue handling, a cleaner and more uniform stromal surface before the refractive ablation, elimination of the chemical effect of alcohol on the stroma, and a potentially smoother epithelial removal zone.

What the evidence shows:

A 2021 prospective study of 200 eyes comparing StreamLight t-PRK with conventional PRK found that visual recovery was significantly faster in the t-PRK group at days four and seven postoperatively, with superior mean uncorrected distance visual acuity compared with the conventional PRK group at both time points (Braun et al., PubMed 33863311).

A 2022 randomised contralateral trial published in BMC Ophthalmology comparing t-PRK with both mechanical debridement PRK and alcohol-assisted PRK found that time to complete epithelialisation was similar across all three methods (approximately 3.6 to 3.7 days). Visual and refractive outcomes were equivalent between all three techniques at six months. The study found that patients experienced less pain and discomfort on the first postoperative day with conventional PRK groups compared with t-PRK, though results were similar beyond the first day (Hashemi et al., BMC Ophthalmol. 2022;22(1). doi: 10.1186/s12886-022-02293-2).

A 2025 randomised controlled study published in Ophthalmology and Therapy confirmed that t-PRK and conventional PRK provide broadly equivalent refractive and visual outcomes at six months, with similar predictability, efficacy, and safety profiles (PubMed 40445504).

In practical terms, t-PRK and conventional PRK achieve equivalent long-term visual outcomes. The main clinical advantage of t-PRK is the avoidance of mechanical tissue handling and alcohol, which some surgeons believe produces a cleaner stromal surface for the laser. The availability of t-PRK depends on the excimer laser platform available at the treating centre. Not all laser systems offer a transepithelial mode.

Mitomycin-C is applied in the same manner after t-PRK as after conventional PRK. The postoperative drop regimen, recovery timeline, and risks are essentially the same for both approaches.

Mitomycin-C: preventing corneal haze

Immediately after the laser treatment is applied to the stroma, mitomycin-C (MMC) is applied to the ablated surface. Mitomycin-C is a topical chemotherapy agent that inhibits the proliferation of keratocytes, the cells responsible for producing the collagen fibrils that cause corneal haze and subepithelial fibrosis after PRK.

Corneal haze is the most important PRK-specific complication. It results from abnormal wound healing in the stroma following laser treatment and can reduce visual quality, particularly contrast sensitivity. The risk of clinically significant haze is highest in corrections above -6.00 dioptres and in hyperopic corrections.

A 2023 review published in Ophthalmology and Therapy covering 102 articles confirmed that mitomycin-C is a highly effective prophylactic agent for preventing both early and late onset corneal haze after PRK. In a meta-analysis, MMC reduced both early and late onset haze rates and improved the predictability of refraction and subjective postoperative visual acuity compared with PRK without MMC.

MMC is applied using a small soaked sponge for 15 to 60 seconds depending on the magnitude of the correction being treated. The cornea is then thoroughly irrigated with saline to wash the MMC away before the bandage contact lens is placed. The application is not felt by the patient.

After MMC application patients are also advised to wear UV-blocking sunglasses outdoors for at least six months postoperatively, as UV-B exposure has been associated with post-PRK haze formation.

Immediately after PRK: the bandage contact lens

At the completion of the procedure a bandage contact lens is placed on the eye. This remains in place for three to five days while the epithelium regenerates. The bandage lens serves two purposes: it protects the raw stromal surface from the environment, and it reduces friction between the eyelid and the healing surface, significantly reducing discomfort.

The bandage contact lens is removed by your surgeon at the five-day review once epithelialisation is confirmed to be complete. Do not attempt to remove it yourself.

Pain management after PRK

PRK is associated with significantly more postoperative discomfort than LASIK. This is because the corneal epithelium, which is rich in sensory nerve endings, has been completely removed. The raw stromal surface is exposed and highly sensitive until the epithelium regenerates over three to five days.

Most patients describe the discomfort as a burning, stinging, gritty, or scratchy sensation, similar to having a foreign body in the eye or a severe corneal abrasion. The first 24 to 72 hours are the most uncomfortable. Discomfort diminishes significantly once the epithelium closes, typically by day four to five.

Ice packs applied gently to the closed eyelids for the first 24 to 48 hours provide meaningful relief. The cold reduces the inflammatory response in the cornea and provides analgesic effect through temperature. Apply a clean ice pack wrapped in a thin cloth for 10 to 15 minutes at a time, several times per hour in the first day. Do not apply ice directly to the eye or press firmly on the eye.

Oral analgesia with paracetamol or ibuprofen taken regularly in the first 48 to 72 hours is appropriate and effective for most patients. Do not wait for pain to become severe before taking oral analgesia. Taking it on a scheduled basis in the first three days maintains a more consistent level of comfort.

Preservative-free lubricating drops used frequently provide surface relief. Cold refrigerated lubricating drops provide additional comfort through the temperature effect on the corneal surface.

Prescription-strength non-steroidal anti-inflammatory drops may be provided for the first few days for additional pain relief. Use these as prescribed.

Postoperative eye drops after PRK

The postoperative drop regimen after PRK is more prolonged than after LASIK because the surface healing process is longer and the risk of haze requires steroid treatment for a longer period.

Antibiotic drops are used four times daily for at least one week, until the epithelium has completely healed and the bandage contact lens has been removed. Infection in the immediate post-PRK period is a serious risk because the stromal surface is exposed while the epithelium regenerates.

Steroid drops are used in a tapering course over three to four months. The steroid is the primary pharmacological prophylaxis against corneal haze. The taper is slow and gradual. In higher corrections, the taper may be extended further. Do not reduce or stop the steroid drops without instruction from your surgeon. Stopping steroids prematurely is a known risk factor for late onset haze.

Lubricating drops are used frequently throughout the day for at least three to six months. PRK produces a more prolonged dry eye state than LASIK and lubrication is important both for comfort and for surface healing.

Vision recovery timeline after PRK

Vision recovery after PRK is substantially slower than after LASIK and requires realistic patient expectations before proceeding. For population-level data on long-term PRK visual outcomes, see the LASIK and PRK outcomes data guide.

Days one to three: vision is blurred and uncomfortable. The epithelium is absent and the stromal surface is swollen. Functional vision is not expected during this phase.

Days three to five: the epithelium closes and the bandage lens is removed. Vision begins to improve but remains blurred and variable.

Week one to two: vision improves progressively but fluctuates. Most patients can perform basic tasks but vision is not yet adequate for driving or return to demanding visual work.

Week two to four: the majority of patients achieve functional driving vision by the end of the second to fourth week. Some patients are slower.

One to three months: vision continues to improve and stabilise. Night vision symptoms including haloes and glare are common. The steroid taper continues.

Three to six months: final refraction stabilises and haze risk diminishes. The steroid is tapered to completion.

Time off work and activity restrictions

Work: most patients require one week off from office-based work, longer if the work is visually demanding or involves dust or chemicals. The first week involves significant visual disability.

Driving: driving is not permitted until vision meets the legal standard in the operated eye. For most PRK patients this occurs between one and four weeks postoperatively. It is confirmed at your postoperative review.

Exercise: light walking can be resumed after the epithelium has closed, typically from day five. Contact sports and swimming should be avoided for at least four weeks. Outdoor activity requires UV-blocking sunglasses from day one.

Risks of PRK

PRK has an excellent long-term safety profile in appropriately selected patients. The main risks are:

Corneal haze: subepithelial haze is the most PRK-specific risk. Mild early haze peaks around two months and late haze peaks around four months. Clinically significant haze is substantially reduced by mitomycin-C and the steroid taper. Significant haze causing visual impairment is uncommon with modern MMC protocols.

Delayed healing: a small proportion of patients experience prolonged epithelial healing beyond five to seven days, particularly those with dry eye or diabetes. This increases infection risk and requires close monitoring.

Infection: the exposed stromal surface during the epithelial healing phase creates an infection risk. Antibiotic drops must be used as prescribed. Symptoms of infection including increasing pain, redness, and blurred vision require urgent same-day assessment.

Regression: some patients experience gradual regression of their correction over years, more commonly in higher corrections and hyperopic treatments. Enhancement PRK or PRK with MMC can be performed to address significant regression.

Undercorrection or overcorrection: as with all laser refractive procedures, a small proportion of patients will have a residual prescription after healing. Enhancement can be considered once the refraction has stabilised, typically after six months.

For patients with keratoconus who have undergone corneal crosslinking: what to expect, topography-guided PRK is sometimes performed after crosslinking has stabilised the cornea to regularise the surface and improve unaided vision.

References

1. 1.Moshirfar M, et al. Management of Corneal Haze After Photorefractive Keratectomy. Ophthalmol Ther. 2023;12(6):2841-2862.
2. 2.Photorefractive Keratectomy. StatPearls. NCBI Bookshelf.
3. 3.A Review of Photorefractive Keratectomy. Review of Ophthalmology. 2024.
4. 4.van der Valk Bouman ES, et al. Pain Mechanisms and Management in Corneal Cross-Linking: A Review. BMJ Open Ophthalmol. 2021.
5. 5.Braun et al. Early clinical outcomes and comparison between trans-PRK and PRK. PubMed 33863311.
6. 6.Hashemi et al. Comparison of transepithelial and conventional photorefractive keratectomy. BMC Ophthalmology 2022.
7. 7.Transepithelial versus Conventional PRK: A Randomized Controlled Study. Ophthalmol Ther 2025.