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Refractive keratitis is corneal inflammation that occurs after refractive surgery such as LASIK or PRK. It can be infectious, caused by microbes, or noninfectious, caused by sterile inflammation in the surgical interface. Symptoms can include pain, redness, light sensitivity, tearing, and blurred vision. Urgent evaluation is needed because delayed treatment can lead to corneal scarring and lasting vision change.
read more about refractive keratitis ...After refractive surgery, the corneal surface barrier is disrupted during healing, which raises infection risk in the early recovery period. Infectious causes include bacteria, fungi, and atypical organisms, and risk rises with contamination, poor drop handling, or delayed epithelial healing. Noninfectious causes include sterile inflammatory reactions such as diffuse lamellar keratitis in the LASIK flap interface. Dry eye, epithelial defects, and debris in the interface can also worsen inflammation and discomfort. A slit-lamp exam is needed to separate infectious keratitis from sterile inflammation.
Symptoms often start as increasing discomfort rather than the expected day-to-day improvement after surgery. Eye pain, foreign body sensation, and strong light sensitivity are common warning signs. Redness, tearing, and blurred vision can occur, and some cases have discharge or a visible white spot on the cornea. Vision can fluctuate as swelling or infiltrates build, and night glare can worsen. A rapid drop in vision, severe pain, or marked redness after LASIK or PRK should prompt same-day contact with the surgeon.
An eye clinician diagnoses refractive keratitis with a slit-lamp exam to look for corneal staining, infiltrates, or interface haze. Fluorescein dye highlights epithelial defects and ulcer patterns. When infection is suspected, corneal scrapings and cultures can guide targeted antimicrobial choice. In post-LASIK cases, the exam focuses on the flap interface to separate diffuse lamellar keratitis from infectious interface keratitis. Visual acuity, intraocular pressure, and healing status are checked to guide treatment and follow-up.
Treatment depends on whether the cause is infectious or sterile inflammation. Infectious keratitis is treated with frequent antimicrobial eye drops and close follow-up, and some cases need flap lifting and irrigation to clear organisms from the interface. Sterile interface inflammation such as diffuse lamellar keratitis is often treated with topical steroids and, in more severe cases, interface washout. Supportive care can include lubricating drops, protective instructions, and stopping contact lenses unless a clinician advises otherwise. Using leftover steroid drops without an exam is risky, since steroids can worsen an untreated infection.
Not always. Diffuse lamellar keratitis is a specific sterile inflammatory reaction that occurs in the LASIK flap interface. Refractive keratitis is a broader phrase that can include diffuse lamellar keratitis as well as infectious keratitis after refractive surgery. An exam is needed because the treatments differ.
Keratitis can appear within days after surgery, especially when healing is delayed or contamination occurs. Some infections and inflammatory reactions can also appear later, even weeks after surgery. Any worsening symptoms after an initial improvement should be checked promptly.
Yes. Infection or severe inflammation can scar the cornea, which can affect clarity and create glare or irregular astigmatism. Early diagnosis and correct treatment can reduce the chance of long-term effects.
Diffuse Lamellar Keratitis. EyeWiki. https://eyewiki.org/Diffuse_Lamellar_Keratitis. Date Accessed February 4, 2026.
LASIK Complications. EyeWiki. https://eyewiki.org/LASIK_Complications. Date Accessed February 4, 2026.
PRK and LASIK: Infectious Keratitis. American Academy of Ophthalmology. https://www.aao.org/education/academy-live/detail/prk-lasik-infectious-keratitis. Date Accessed February 4, 2026.
Infectious Keratitis After Refractive Surgery: A Narrative Review. Frontiers in Medicine (PMC). https://pmc.ncbi.nlm.nih.gov/articles/PMC9151363/. Date Accessed February 4, 2026.
Infectious Keratitis. American Academy of Ophthalmology. https://www.aao.org/eye-health/diseases/infectious-keratitis. Date Accessed February 4, 2026.