Dr. Barnett’s Breakthrough Research on Post-Surgery Eye Discomfort (STODS)
Preoperative optimization is central to Dr. Bradley Barnett’s research on STODS, Surgical Temporary Ocular Discomfort Syndrome, the brief dryness an eye can feel while healing after surgery. Because Dr. Barnett co-defined this condition, our team treats the eye’s surface before your procedure, not just after. That preparation is what gives us accurate preoperative measurements to plan your surgery around, which leads to a smoother recovery and clearer vision. Any temporary dryness resolves as the corneal nerves heal, typically within about a year.
What This Study Is About
Dr. Bradley Barnett of California LASIK & Eye has spent his career researching how the eye heals after surgery, and his latest work tackles a question nearly every surgical patient asks: why does my eye feel dry or gritty even after a successful procedure? Co-authored with Dr. Matthew Hirabayashi, “Solving STODS—Surgical Temporary Ocular Discomfort Syndrome” was published in Diagnostics, Volume 13, Issue 5, Article 837, on February 22, 2023. In it, the two doctors name and define this experience Surgical Temporary Ocular Discomfort Syndrome, or STODS, giving surgeons and patients alike a clearer way to understand what’s happening after LASIK, PRK, or cataract surgery.
The article explains why STODS occurs. Corneal surgery cuts through some of the tiny nerve fibers that keep the eye surface moist and comfortable. These nerves regrow within about a year, which is why the discomfort is temporary rather than permanent. The amount of nerve disruption varies by procedure. Cataract surgery causes the least, LASIK causes more, and newer laser techniques like SMILE fall in between.
The authors argue that surgeons and optometrists should work together before surgery, not only after. They describe a co-management approach called Guided Ocular Surface and Lid Disease, or GOLD, optimization. It includes testing tear film stability, checking the meibomian glands, and treating inflammation with drops, warm compresses, or newer options like amniotic membrane grafts, before surgical measurements are ever taken. Better preoperative testing leads to more accurate lens calculations and sharper results.
Left untreated, the authors note, temporary discomfort can occasionally turn chronic, a condition they call Surgical Chronic Ocular Discomfort Syndrome, or SCODS. Catching and treating dry eye signs early, even in patients who feel no symptoms yet, is the best way to prevent that shift.
For anyone considering LASIK, PRK, SMILE, or cataract surgery, this research explains why Dr. Barnett and our team screen the ocular surface so closely before any procedure begins.
Why Eyes Feel Different After Surgery
Every eye surgery, whether it’s LASIK, PRK, SMILE, or cataract surgery, touches nerve endings on the surface of the cornea. Those nerves do more than sense pain. They also help trigger normal blinking and tear production. When surgery disrupts them, patients notice dryness, a gritty feeling, or light sensitivity, even when the surgery itself went perfectly.
Dr. Barnett and Dr. Hirabayashi point out that this is different from chronic dry eye disease. It’s a temporary side effect of healing, not a separate diagnosis. The nerves regrow over time, largely by the one-year mark, and comfort returns as they do.
Not every procedure affects the nerves the same way. Cataract surgery involves a small incision and disrupts the fewest nerves. LASIK creates a thin flap in the cornea and temporarily severs more of them. Newer techniques, like SMILE, sit in between, since they work through a much smaller opening.
Why the Eye’s Surface Matters Before Surgery Even Starts
Before any refractive or cataract procedure, the surgical team takes precise measurements of the eye’s shape and curvature. Those measurements guide everything from the surgical plan to the strength of the lens implant used in cataract surgery.
A dry or unstable tear film throws those measurements off. The study notes that many patients already have some degree of ocular surface irritation before surgery, often without realizing it or having a formal dry eye diagnosis. If that irritation isn’t addressed first, the surgeon may be working from inaccurate numbers, which can affect the final visual outcome.
This matters most for patients choosing premium lens implants designed to reduce dependence on glasses after cataract surgery. Those lenses are more sensitive to surface irregularities, so getting the eye’s surface healthy and stable beforehand has a direct effect on how happy a patient is with their vision afterward.
How Doctors Check the Eye’s Surface Before Surgery
A thorough pre-surgical exam looks for early signs of surface irritation. This includes checking how quickly tears evaporate off the eye, examining the eyelid margins and oil-producing glands, and looking for tiny areas of surface irritation on the cornea.
Some of this testing has traditionally required numbing drops and dye, which can interfere with other measurements taken the same day. The authors highlight newer, non-invasive imaging tools that assess tear stability without drops, so testing doesn’t interfere with the rest of the pre-surgical workup.
What’s Happening at the Cellular Level
Underneath the surface symptoms, surgery sets off a cascade of biological changes. Cutting corneal nerves triggers local inflammation. That inflammation, in turn, can affect the glands that produce the oily layer of the tear film and the cells that help keep the eye’s surface lubricated.
The authors describe this as a cycle: irritation leads to inflammation, inflammation leads to a less stable tear film, and an unstable tear film leads to more irritation. Genetics and conditions like rosacea can make some patients more prone to this cycle than others. The eye’s surface also hosts its own microbiome, a community of natural bacteria, and disruptions to that balance can play a role in ongoing irritation as well.
Different procedures set off this cycle to different degrees. PRK allows nerves to reconnect relatively quickly. LASIK severs a larger share of surface nerves and takes longer for sensation to fully return. SMILE, because it works through a much smaller opening, tends to preserve more of the surrounding nerve network and shows an easier recovery of corneal sensation.
How Surgeons and Eye Doctors Get Ahead of It
Rather than waiting for discomfort to appear after surgery, the authors recommend addressing the ocular surface beforehand, in partnership between the referring optometrist and the surgeon. Depending on what the exam finds, this can include:
- Simple lifestyle adjustments, like redirecting fans and air vents away from the eyes, or using an overnight ointment for patients who don’t fully close their lids during sleep
- Preservative-free artificial tears and temporary punctal plugs, which slow tear drainage
- Warm compresses, in-office heat treatments, or light-based therapies that help unclog and restore function to the oil-producing glands along the eyelids
- Prescription anti-inflammatory eye drops for patients with more significant irritation
- Nutritional support, such as omega-3 supplements, to help support tear quality over time
- In select cases, biologic treatments derived from amniotic tissue, which can help calm inflammation and support nerve healing
The right combination depends on what’s actually driving the irritation for that individual patient. A regimen aimed at oil gland dysfunction looks different from one aimed at inflammation or nerve sensitivity.
What Happens in the Operating Room
Choices made during surgery itself also affect how the eye’s surface recovers. The authors point to a few surgical practices that appear to help: keeping antiseptic irrigation techniques in place during cataract surgery to reduce the need for prolonged postoperative antibiotics, and using gentler surgical lubricants on the eye’s surface during the procedure to prevent unnecessary drying.
For laser vision correction, the choice of technique and settings also plays a role. Procedures that disturb fewer corneal nerves, and femtosecond laser settings kept to the lowest energy needed, are associated with less surface disruption afterward.
Recovering After Surgery
Once surgery is done, the goal shifts to supporting healing without over-treating the eye. The authors note that minimizing unnecessary antibiotic drops after surgery may help the eye’s natural microbiome bounce back faster. Similarly, using non-drop delivery methods for anti-inflammatory medication, such as a dissolving punctal insert or an injectable steroid placed during surgery, can reduce the total number of preserved eye drops a patient needs to use during recovery.
For patients who received a multifocal or extended depth of focus lens during cataract surgery, staying on a prescribed anti-inflammatory drop after surgery has been shown to support better visual outcomes, since these lens types are especially sensitive to any surface irregularity.
When Temporary Discomfort Doesn’t Go Away
In most patients, this post-surgical discomfort resolves within weeks to months as the corneal nerves heal. But the authors caution that if it’s ignored or under-treated, it can occasionally settle into a longer-term problem, which they term Surgical Chronic Ocular Discomfort Syndrome, or SCODS.
The patients most at risk appear to be those who already had some degree of undiagnosed surface irritation going into surgery. This is the core argument of the paper: identifying and treating ocular surface issues before surgery, not just reacting to symptoms afterward, is what keeps temporary discomfort from becoming a lasting problem.
The Bottom Line
Some degree of dryness or irritation after eye surgery is normal and expected. It is a byproduct of healing, not a sign that something went wrong. The research makes the case that a proactive, coordinated approach between optometrist and surgeon, addressing the ocular surface before surgery rather than only treating symptoms after, leads to more accurate measurements, smoother recoveries, and better long-term comfort for patients.
If you live in Sacramento, Roseville, Folsom, or the surrounding area and you’re considering LASIK, PRK, SMILE, or cataract surgery, this kind of research is exactly why our pre-surgical advanced diagnostic technology and evaluations are so thorough. Dr. Barnett and our team screen the health of your eye’s surface before recommending any procedure, so your outcome is built on accurate measurements from the start. Contact California LASIK & Eye today to schedule a consultation with Dr. Barnett and find out whether vision correction surgery is right for you.
Source: Hirabayashi MT, Barnett BP. Solving STODS—Surgical Temporary Ocular Discomfort Syndrome. Diagnostics. 2023;13(5):837. doi:10.3390/diagnostics13050837. Licensed under CC BY 4.0.
