Bilateral Corneal Flap Dislocation Without Trauma Two Decades After LASIK
Overview
This case report describes a rare instance of bilateral corneal flap dislocation occurring 20 years post-LASIK surgery without any trauma. The patient presented with severe symptoms and was successfully treated with surgical flap repositioning and management of underlying dry eye disease.
Background
LASIK is a widely used refractive surgery with generally stable long-term outcomes. However, flap dislocation is a known complication, typically occurring shortly after surgery or following trauma, and usually unilaterally. Late-onset flap dislocation without trauma is extremely rare. This report highlights a unique case of chronic bilateral flap dislocation two decades after LASIK, associated with severe dry eye and habitual eye rubbing.
Data Highlights
Parameter
Right Eye (OD)
Left Eye (OS)
Visual Acuity at Presentation
Hand motion
Hand motion
Schirmer I Test
4 mm
5 mm
TBUT
3 seconds
3 seconds
Postoperative Visual Acuity
20/40 uncorrected
20/40 uncorrected
Key Findings
Bilateral corneal flap dislocation occurred 20 years after LASIK without any traumatic event.
Severe evaporative dry eye disease with meibomian gland dysfunction was present, likely contributing to flap instability.
Clinical signs included corneal flap edema, wrinkling, displacement, and neovascularization at flap edges.
Surgical flap repositioning with epithelial debridement and bandage lens placement led to flap reattachment and symptom relief.
Postoperative corneal topography showed improved corneal symmetry, though visual acuity remained at 20/40 uncorrected.
Management of underlying dry eye and MGD was essential to prevent recurrence.
Clinical Implications
Clinicians should be aware that LASIK flap dislocation can occur even decades after surgery without trauma, especially in patients with severe dry eye and habitual eye rubbing. Prompt surgical intervention is critical to restore flap position and improve visual outcomes. Additionally, addressing underlying ocular surface disease such as meibomian gland dysfunction is important to maintain flap stability and ocular health.
Conclusion
This case underscores the potential for very late bilateral LASIK flap dislocation in the absence of trauma, highlighting the need for long-term vigilance and comprehensive ocular surface management in post-LASIK patients. Surgical flap repositioning combined with dry eye treatment can achieve favorable outcomes.
Related Resources & Content
Various Authors 2024 -- Bilateral Corneal Flap Dislocation Without Trauma Two Decades Following LASIK Surgery
