The Dry Eye Zone

Rebecca's Blog


Abstract: SMILE incision size does not impact dry eye symptoms

This study says that for dry eye purposes, the incision size does not matter, therefore it’s OK to make larger incisions when you’re inexperienced and graduate to smaller incisions over time.

I suppose I would be fine with this if it weren’t giving me flashbacks to all those old cheerleader studies about the LASIK flap and the insistence for so many years that no matter how you make a flap, it doesn’t really matter to the patient afterwards. Ah well.

Cornea. 2018 Oct 10. doi: 10.1097/ICO.0000000000001782. [Epub ahead of print]

Influence of Incision Size on Dry Eye Symptoms in the Small Incision Lenticule Extraction Procedure.

Cetinkaya S, Gulmez M, Mestan E, Ucar F, Ali N.



To evaluate the influence of incision size on dry eye symptoms in the small incision lenticule extraction (SMILE) procedure.


Ninety-four eyes of 47 patients with myopia and/or myopic astigmatism who had undergone the SMILE procedure were enrolled in this study. The patients were divided into 3 groups according to the incision size (2, 3, and 4 mm) applied during the SMILE procedure.


There were no significant differences among the groups in respect to age and sex (P values 0.251 and 0.974, respectively) and in respect to preoperative, postoperative first day, first week, first month, third month, and sixth month values of the Ocular Surface Disease Index score, tear break-up time, ST1, and staining grades.


There was no difference in dry eye symptoms with 2-, 3-, and 4-mm incisions. In the learning period of SMILE surgery, larger incision sites can be used to make the procedure easier.