A 29-year-old woman with -5.0 D myopia requests laser vision correction. She has well-controlled systemic lupus erythematosus on immunosuppressants, a Schirmer test of 3 mm, and a stable refraction for two years. The MOST appropriate advice is:

• A Decline corneal refractive surgery; consider phakic IOL or spectacles/contact lenses ✓
• B Proceed with SMILE, which avoids all healing-related risks
• C Proceed with LASIK, as systemic disease control makes outcomes equivalent
• D Proceed with PRK after one week of intensive lubricants

Explanation

Systemic autoimmune disease with significant dry eye is a relative to absolute contraindication to corneal refractive surgery because impaired wound healing, persistent epithelial defects, and severe postoperative dry eye are common. No flap-based or surface ablation technique circumvents this. Refractive stability alone does not qualify her. Alternatives that do not wound the corneal surface, such as phakic IOL implantation or continued optical correction, are appropriate.

Reference: Yanoff and Duker Ophthalmology, 5th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.