Possible Risks & Complications of SMILE

Visual surgery is a common way to treat vision problems. When it goes right, patients requiring severe corrective lenses can be left with near-perfect vision. In recent years, laser surgeries have dominated the field. They provide faster, safer and more precise means for doctors to fix eye problems. One of the newest and most popular treatments is known as SMILE. It has a lot to offer, but like any vision correction, it comes with risks. Those risks will be discussed in detail right here.

What Is SMILE?

SMILE is an acronym for small incision lenticule extraction. While it’s not a perfect acronym of those terms, the “m” is kept from “small” to make it an easier vernacular to use. More importantly, SMILE is a laser eye surgery that uses some of the latest technology. It utilizes a special femtosecond laser to provide incredibly precise sculpting techniques for the surgeon to correct vision issues. 

The SMILE procedure involves using the femtosecond laser to build up the matter within the corneal flap. Once the area is shaped, the same laser will make an incision, and the excess tissue will be removed. This effectively creates a new lens shape on the cornea, correcting vision problems. The procedure typically heals within days, and it produces rapid vision improvement.

It’s important to understand that SMILE has been developed specifically to treat nearsightedness. It can be used to treat cataract issues, astigmatism and other sources of nearsightedness.

The Risks and Complications

These are risks, complications, and side-effects. None of these issues are expected to happen. In fact, most of the impact a severe minority of patients, but these issues have been observed and should be considered as possible risks. Here is your complete list of SMILE laser eye surgery side effects. 

Night Vision Issues

Any laser surgery has a risk of side-effects regarding night vision. In general, glare from bright lights and halos around lights are known to happen. This doesn’t necessarily afflict patients immediately out of the operation. It can develop years later. The glare and halos can also occur during the day. That said, the issue is usually at its worst when bright lights contrast against general darkness.

Night lenses can help deal with the glare and halos, and other treatments may be available for extreme cases.


The extraction SMILE procedure involves removing tissue from the surface of the cornea. This leads to a possible issue of debris, and it typically stems from the removal of the corneal disc. The debris can include additional problems of its own, including irritation and inflammation. 

In extreme cases, the debris may require a followup treatment, but in most cases, it can be flushed with non-invasive treatments. Debris symptoms are typically temporary, but they can add to recovery time and make recovery more complicated in general.


Any treatment includes a risk of infection. SMILE infection risks are much smaller than most surgical procedures, but the risk does exist. Infections are usually curable when caught early, so it’s important to be on the lookout for symptoms.

Red eyes, excessive itching, pain or a loss of vision are the primary indicators that a patient may be suffering from an infection. Contacting the ophthalmologist immediately is the best way to receive treatment and resolve the issue. Typically, prescription eye drops will be used for a remedy and can even prevent infection in the first place.


While inflammation is not an expectation, it is one of the more common side-effects and is typically accounted for in the recovery process. Inflammation can impact vision and lead to discomfort in the face or headaches. 

In the majority of cases, inflammation is temporary and treatable. In extreme cases, it can make recovery more complicated and add to total recovery time. Any pain, vision problems or other signs of inflammation should be communicated to the doctor for treatment.

Clouded Vision

Clouded vision makes everything in sight appear to be hazy. It can be temporary or permanent, depending on circumstances, but it is not a common issue. Clouded vision is at a higher risk for more extreme nearsightedness. Because of this, your doctor should discuss this risk depending on the level of correction you need.

In most cases, clouded vision is not debilitating and is not related to suction loss.

Double Vision

Double vision will most often present as seeing a ghost image. This is a type of double vision called diplopia. It stems from a slight misalignment between the image receptors. When this happens, the brain can struggle to reconcile the separate images coming from each eye. As a result, the ghost image will perform alongside the “true” image.

When severe enough, double vision can lead to follow up procedures for correction. The nature of that followup will be determined case by case, but as the issue is usually created in the surgical process, it is often treatable.

Dry Eyes

This issue is notably less common with SMILE than other laser surgeries. That said, it is still the most common side-effect reported by laser surgery recipients. In most instances, the dry eye symptoms will be at their worst directly after the operation is performed and lessen over time. They can be treated with lubricating drops.

Dryness is a larger concern for people with a pre-existing issue with dryness. The excimer laser can exacerbate those symptoms, and the ophthalmology consultant should discuss this issue beforehand, especially in a case of suction loss.


It is possible to over or under correct vision problems with a SMILE Lasik operation. This issue is not unique to SMILE. Regardless, vision problems can be worse after the operation than before. In the case of under-correction, vision problems will be reduced, but not to the point of expectation. In overcorrection, nearsightedness may be replaced by farsightedness.

Miscorrection can lead to retreatment. The nature of that treatment will have to be discussed by the surgeon and patient. In some cases, a repeat of a procedure is sufficient. In other cases, a separate procedure may be warranted.

Cornea Bulging

This is one of the most uncommon side-effects of the procedure. It can happen if the eye becomes weak. In that case, the lens will bulge forward. Bulging is an issue that can affect people without ever having refractive surgery. Corrective surgeries increase the risk of bulging in a case of weakened eyes, but it is very uncommon.

Bulging can lead to vision problems. They will typically be treated with corrective glasses or contact lenses. In the most extreme cases, a transplant can be used to resolve the issue.


Incision lenticular extraction SMILE involves cutting flesh. That means that the worst-case scenario includes blindness or partial loss of sight. It is exceedingly uncommon, but the risk does exist and must be discussed. Any eye operation can potentially go wrong and lead to blindness. It is something your surgeon should discuss before committing to the procedure.

Other general medical issues can be attached to this treatment course, but they are no more likely with SMILE than any other application. The full list of risks and issues should always be discussed with your doctor before proceeding with treatment.

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