Both LASIK and SMILE correct common refractive errors, but SMILE may be preferred for patients prone to dry eyes because its flapless, small-incision design disrupts fewer corneal nerves. The best option depends on your prescription, corneal profile, and clinical assessment.

What are LASIK and SMILE?

LASIK (Laser-Assisted In Situ Keratomileusis)

LASIK is the world’s most performed elective surgery, with over 40 million procedures completed globally. A femtosecond laser creates a thin corneal flap, and an excimer laser reshapes the cornea to correct vision.

For dry eyes, the key concern is that the flap can disrupt corneal nerves that help regulate tear production. This may cause or worsen dry eye symptoms, especially during the first 3–6 months after surgery.

SMILE (Small Incision Lenticule Extraction)

SMILE is a newer, flapless eye surgery. A femtosecond laser creates and removes a thin lenticule through a small 2-4 mm incision, with no flap required. SMILE treats myopia and astigmatism.

For dry eyes, the key benefit is that SMILE’s smaller incision preserves more corneal nerves. Studies report lower rates and shorter duration of dry eyes.

How each procedure affects dry eyes 

The cornea is highly innervated; its nerves detect dryness and signal tear production. Surgery can disrupt this feedback loop.

LASIK and corneal nerve disruption

LASIK’s flap incision widely affects corneal subbasal nerves, leading to:

• Reduced corneal sensitivity for 3–6 months on average
• Temporary decrease in tear secretion
• Dry eye symptoms (grittiness, burning, light sensitivity) in roughly 20‑40% of patients in the first 3‑6 months
• Full nerve regeneration in most patients within 6‑12 months

Patients with normal tear function usually manage LASIK dryness with drops; pre-existing dry eye may worsen and warrants careful evaluation.

SMILE and reduced nerve impact

SMILE’s small peripheral incision largely preserves the central corneal nerve plexus. Peer-reviewed studies, including publications in the Journal of Cataract & Refractive Surgery, consistently report:

• Faster corneal nerve regeneration after SMILE
• Lower incidence of clinically significant dry eye post-operatively
• Better preservation of corneal sensitivity at 1, 3, and 6 months

For patients with mild-to-moderate dry eye who still wish to pursue laser vision correction, surgeons typically recommend SMILE first.

LASIK vs. SMILE: Side-by-side comparison

General clinical evidence shown; individual results vary. Eligibility determined via LASIK MD for a pre-op exam.

Who should choose SMILE over LASIK for dry eyes?

While each surgery suits for a specific candidate, SMILE is worth prioritizing if you identify with one or more of the following profiles:

• Contact lens intolerance: SMILE may reduce the risk of worsening dryness or irritation.
• Dryness-prone lifestyles: Pilots, athletes, and screen-heavy users may benefit from faster tear-film recovery.
• Thin corneas with dry eye history: SMILE may be an option when LASIK is not suitable.
• Flap concerns: SMILE’s flapless design may suit active patients or those at risk of eye impact.

Not sure which procedure is right for you? LASIK MD’s free, no-obligation consultation includes a dry eye assessment, so your surgeon can recommend the best option for your tear function, prescription, and lifestyle.

What to expect: The pre-op dry eye assessment at LASIK MD

Before recommending any procedure, LASIK MD clinicians assess your tear film in detail. Here's what the evaluation typically covers:

• Schirmer’s Test: Measures tear production.
• Tear Break-Up Time: Checks tear film stability between blinks.
• Corneal Topography: Maps corneal shape and thickness.
• Meibomian Gland Evaluation: Assesses oil-producing tear glands.

If dry eye is detected, your care team may recommend treatment before surgery, such as warm compresses, omega-3s, or prescription drops. Treating dry eye first may improve your candidacy.

How much does SMILE cost vs. LASIK in Canada?

Pricing for both procedures varies by location, prescription complexity, and technology. These prices are presented as estimates around Canada:

Prices are indicative and are subject to change. Most private health insurance plans do not cover laser eye surgery, but many providers include it in their Health Spending Accounts (HSA).

Am I a good candidate for LASIK or SMILE if I have dry eyes?

Dry eye does not automatically disqualify you from laser vision correction. Candidacy depends on severity, cause, and whether dryness can be managed or treated beforehand. General guidelines include:

• Mild dry eye: Often eligible for both LASIK and SMILE. Pre-treatment may be recommended.
• Moderate dry eye: Assessed case-by-case. SMILE may be more appropriate.
• Severe/Chronic Dry Eye: Usually disqualifies patients for both procedures until stabilized. Implantable lenses (ICL) may be considered as an alternative.

Other standard candidacy criteria apply regardless of dry eye status:

• Age 18 or older with stable prescription for at least 12 months
• Sufficient corneal thickness for tissue removal
• No active ocular infection or pathology (e.g., keratoconus)
• Realistic expectations and understanding of outcomes

Frequently asked questions