Autoimmune disease is listed as a contraindication to laser in situ keratomileusis (LASIK) and other corneal procedures to improve visual acuity. There is debate whether this is an absolute or relative contraindication.
Autoimmune diseases included rheumatoid arthritis, SLE, psoriatic arthritis, scleroderma, Sjogren's, spondyloarthropathy, inflammatory bowel disease, and autoimmune thyroiditis.
Autoimmune diseases may be:
(1) associated with active intra-ocular inflammation
(2) dry eye
(3) steroid therapy
(4) immunosuppression and/or immunodeficiency
Complications of a corneal procedure may include:
(1) corneal melting
(2) corneal infection
(3) corneal clouding
(4) corneal scarring
Everyone agrees that an active autoimmune disease is a contraindication to a corneal procedure.
Controversy exists for patients with inactive autoimmune disease. Corneal procedures have been performed successfully in carefully selected patients with a history of an autoimmune disease. On the other hands, a sudden flare-up might occur without warning or a patient may be placed on a corticosteroid.
Simpson et al (2012) suggested that a patient with an autoimmune disease may be a candidate for LASIK if:
(1) the disease is very well-controlled
(2) there is no or minimal ocular involvement
(3) there is no evidence of dry eye (effectively excludes Sjogren's syndrome)
