Please tell me if you think that having an astigmatism of 1.0 in my left eye and a .50 in my right eye is cause for daily headaches?i am seeing 20/20 im my right eye and 20/30 in my left eye.This doesn't seem to be a significant difference between the two, but I really do not want to do an enhancement as I did not recover easily and am still dealing with dry eye as well at 10 weeks post op.

My opinion would be that a combination of things has all conspired to cause your headaches.

Your eye could be having a hard time adjusting to the new vision. If you are near or over age 40, the lens may be working hard to change focus in a range that was not required before. This is called accommodation. The astigmatism could be contributing as could the small imbalance between the two eyes.

The most likely culprit is the dry eye. If the headaches are similar in nature as a sinus headache, I’d focus on the dry eye as the source of the problem. Dry eye will slow healing and exacerbate other problems as well.

There are many things you can do to reduce LASIK induced dry eye. A Shirmer test can determine if the quantity of the tears before they are flushed away through the tear ducts is appropriate. If you are lacking in tears, preservative free artificial tears is an obvious first step. They need to be without preservatives, because the preservative can actually cause dry eyes. Thera Tears is one brand. Preservative free lubricating gels are available for use at night. Punctal plugs can slow the quantity of tears that escape. These can be temporary or long term. You have these drains in the upper and lower lids, so any or all can be plugged as needed.

A Tear Break Up Test (TBUT) can help determine the quality of your tears. The outer layer of tears is oily and helps keep the water below from evaporating. If the oil is diminished or poor quality, you can be making tears like mad but they will evaporate too quickly. Many patients have said flax seed oil taken orally once a day makes a big difference. Apparently the oil is much better than the tablets, but be sure to mix it in something like fruit juice. It tastes awful. The glands that provide this oil are located at the base of the eyelashes. A gentle scrubbing and warm compress can increase flow and production.

It is possible that the dry eye is a combination of things and will require a combination of treatments, but the important message is that well lubricated eyes will heal faster and are less likely to cause pain, including headaches.

You need to also consider the possibility that stressing over your vision difficulties is causing headaches. A bit of relaxation may be in order.

Glenn Hagele
Council for Refractive Surgery Quality Assurance
http://www.usaeyes.org

I am not a doctor.

hey Glenn, thank you so much for your immediate response. Funny you should mention they dry eye situation. At my first ck up post-op I was told that my right eye had a very deep abrasion from the cutting of the flap.That was very painful and slow to heal! Second, I was told at a later ck up that my eyes had severe dry eye and that my corneas looked like sand paper,which at that very moment they inserted plugs in my lower lids.Since that point of time, my dry eye seems better than before and has improved dramatically ,however the dr. said there was still some roughness at this time(8wks). I have slowed down on my usage of drops which i am using thera tears during the day and gel at bedtime. Maybe i should not have eased up so quickly on the drops.I was using them every 2 hrs before and now i am only using them 3-4times daily.I guess my real question is would my level of astigmatism be large enough to really cause headaches in the first place?I think I am going to go back to using my drops more often to see. Please let me know your thoughts on this and again thanks for writing back so soon!

I believe that if you treat the dry eyes you will find more significant headache relief than if you treated the small remaining astigmatism. Hopefully a physician will provide a more educated opinion.

Glenn Hagele
Council for Refractive Surgery Quality Assurance
http://www.usaeyes.org

I am not a doctor.

hey Glenn, you are really great at responding so quickly. I went to the dr. today and he told me that my dry eye situation looks really good now and that he can't understand why I still have headaches every day.He also thought that having an astigmatism of .25-.50 in one eye and a .75-1.0 in the other eye would not cause headaches either.In addition, he feels like my eyes are pretty much stabilized at this time as they ahve had the same readings 3 times now.Again it has been 10 weeks since lasik .Would a topography test tell us anyting or not and why is it that he cant give me an answer as to why I have these headaches daily that I never ahd before and they do feel like eye strain all the time.Do u even consider a 1.0 astigmatism very high or is that still considered mild?