Table 1.

Measures to reduce occurrence of keratitis post laser refractive surgery

Before surgery		During surgery		Post surgery
Aspect	Management	Aspect	Prevention/Management	Aspect	Management
Dry eyes: Foreign body sensation/light sensitivity/discomfort/TFBUT <10 sec/Schirmer’s <10 mm	- Lubricating eye drops and gels (CMC/HPMC/PEG + PG/Sodium Hyaluronate)	Tissue handling	- Adequate surgical training/supervised surgeries for new surgeons	Epithelial defects	Bandage contact lens/4th generation fluoroquinolone (moxifloxacin eye drops)/restrict use of topical corticosteroids till the epithelial defect heals
	- Rule out Sjogren’s syndrome/neurotrophic conditions/ocular surface diseases/vitamin deficiencies/lacrimal disorders		- Careful flap lifting (LASIK) and stromal dissection (SMILE) techniques
			- Avoiding high-energy ablations
Blepharitis/MGD: Irritation/itching/blocked meibomian orifices/frothy secretions/eyelid crusts	Warm compresses/lid massage, antibiotic ointment (chloramphenicol/azithromycin), systemic doxycycline in severe cases	Sterility	- Adequate preparation of ocular adnexa with 10% povidone iodine solution at least 10 minutes prior to surgery	Follow-up and care	- Regular follow-up; at least a minimum of 3 in the first month on post- operative day 1, day 7 and day 30
			- Disposable gloves/gowns/surgical drapes		- At each visit, look for persistent epithelial defects/corneal infiltration/any visual loss
			- A 3 monthly quality check of autoclave units		- Reinforce importance of eye drop administration/avoiding exposure to dust/contaminated water/irritants
			- Pure and contaminant free water to clean instruments
			- Avoiding re-usable blades
			- Different set of instruments for each eye

TFBUT=Tear film break up time, MGD=Meibomian gland dysfunction, CMC=Carboxymethylcellulose, HPMC=Hydroxypropylmethylcellulose, PEG=Polyethylene glycol, PG=Propylene glycol, LASIK=Laser in-situ keratomileusis, SMILE=Small incision lenticule extraction