What Is PRK Surgery? Surface Ablation, Recovery, Pain and Who It Suits

What Is PRK Surgery?

PRK is a laser procedure that removes the thin outer skin of the cornea (the epithelium) and then reshapes the cornea's surface with an excimer laser to correct your power. The epithelium is the same layer that heals when you scratch your eye — it grows back by itself, usually within 3–5 days.

The main steps:

1. Numbing drops are put in; you stay awake and there are no injections.
2. The epithelium is removed — with a dilute alcohol solution, a fine brush, or the laser itself, depending on the technique.
3. The excimer laser reshapes the corneal surface, usually in under a minute.
4. A soft bandage contact lens is placed on the eye to protect it and reduce discomfort while the surface heals.

PRK uses the same excimer laser technology as LASIK. The difference is only where the laser works: on the surface (PRK) versus under a flap (LASIK). Because nothing is cut and lifted, there are no flap-related complications and the whole corneal thickness remains available.

Types of Surface Ablation: ASA, StreamLight and Epi-Contoura

Advanced surface ablation (ASA) is the umbrella term for flap-free laser treatments. The variants differ mainly in how the epithelium is removed and how the treatment is planned:

• Conventional PRK — the epithelium is loosened with alcohol or gently brushed away, then the laser treatment is applied.
• LASEK and Epi-LASIK — older variations that try to preserve the epithelial layer and lay it back; they are used less often today.
• Transepithelial PRK (StreamLight) — StreamLight is Alcon's version on the WaveLight EX500 laser. The laser removes the epithelium as well as correcting the power, so no instrument or alcohol touches the eye. It is often called 'no-touch' PRK.
• Epi-Contoura — a name centres use for topography-guided (Contoura) treatment carried out on the corneal surface instead of under a flap. It can be useful for some irregular or thinner corneas. Exact techniques vary between surgeons, so ask how your centre performs it.

Whichever variant is used, the healing process is similar: the surface needs a few days to close and several weeks for vision to sharpen fully.

Who Is PRK Best Suited For?

PRK is often the preferred choice when a flap is undesirable or not safe. Your surgeon may recommend it if you have:

• A thin cornea that cannot safely accommodate a LASIK flap
• A job or sport with a risk of eye injury — uniformed services, police, boxing, martial arts and other contact sports
• Previous corneal surgery, including a touch-up after SMILE
• Epithelial basement membrane dystrophy or other surface conditions where a flap could heal poorly
• Mild corneal irregularity that is better treated on the surface with a topography-guided plan
• Career rules that favour surface or flapless procedures — see our guide on LASIK for army, police and pilots, and confirm the current rule with your recruiting body

PRK is less suitable if you cannot take around a week off, need sharp vision within a day or two, or have very high power where haze risk is greater — your surgeon may then suggest SMILE, LASIK or an implantable lens.

How Long Does PRK Recovery Take?

Most patients are back to normal daily activities in about one week, but vision continues to improve for one to three months. A typical timeline:

• Day 0–1: Vision is blurry and the eyes water and feel sensitive to light. Rest at home with your eyes closed as much as possible.
• Day 2–3: Usually the most uncomfortable period. Vision can actually feel worse than on day one as the new surface grows in.
• Day 3–5: The epithelium closes. The bandage contact lens is usually removed at the clinic around day 4–7.
• Week 1–2: Discomfort settles. Most people can return to desk and screen work, though vision may still fluctuate during the day.
• Week 2–4: Vision becomes clear enough for most tasks; reading small print and night vision keep improving.
• Month 1–3: Vision sharpens to its final level for most prescriptions. Higher prescriptions can take a little longer, occasionally up to six months.

You will normally use antibiotic drops for the first week and steroid drops on a tapering schedule for several weeks, sometimes a few months. Steroid drops can raise eye pressure in some people, which is one reason the follow-up visits matter.

Is PRK Surgery Painful?

During the procedure most people feel pressure rather than pain, but the first two to three days afterwards are usually uncomfortable — more so than LASIK or SMILE. During surgery the numbing drops mean you feel only light pressure and see the laser's lights.

Once the numbing wears off, most patients describe:

• A gritty, 'sand in the eye' feeling
• Burning or stinging and heavy watering
• Strong sensitivity to light
• For some people, a dull ache

How it is managed:

• The bandage contact lens protects the raw surface and reduces discomfort considerably
• Your surgeon will prescribe pain relief and may give anti-inflammatory drops
• Cool, chilled lubricant drops, dark glasses and resting with your eyes closed help
• Numbing drops are never sent home with you, because repeated use damages healing

Call your clinic promptly if pain gets worse after day three instead of better, if the bandage lens falls out (do not put it back yourself), or if you notice discharge, increasing redness or a sudden drop in vision.

How Long After PRK Does Vision Clear?

Vision is usually functional within about a week, good enough for most tasks by two to four weeks, and at its final sharpness by around three months. The early weeks are often a little up and down — clearer in the morning, hazier by evening, or one eye ahead of the other. That is normal while the new surface smooths out.

Things that help vision clear steadily:

• Using drops exactly as prescribed, including tapering the steroid drops on schedule
• Using lubricant drops frequently, especially in air-conditioned rooms
• Wearing good UV-blocking sunglasses outdoors for the first few months, because strong sunlight is thought to increase the risk of corneal haze after surface treatment
• Not judging the result in the first fortnight — your surgeon will assess it at the follow-ups

For higher corrections, some surgeons apply a medication during surgery to reduce the risk of haze. Ask whether this applies to you.

Driving, Swimming, Work and Screens After PRK

Most PRK restrictions last longer than after LASIK because the surface needs time to heal. As a general guide — your surgeon's advice always comes first:

• Driving: Do not drive until your surgeon confirms your vision meets the legal driving standard, which is usually one to two weeks after PRK. Avoid night driving until glare and halos have settled.
• Swimming: Keep pool, sea and lake water out of your eyes until your surgeon clears you. Most surgeons ask you to wait at least two to four weeks for a clean chlorinated pool with well-sealed goggles, and longer — often six to eight weeks — for sea, lake or river water and hot tubs, because of the infection risk to a healing cornea.
• Work: Desk and screen work is usually possible after about a week. Dusty, outdoor or physical jobs may need longer.
• Screens: Short periods are fine after the first few days; take frequent breaks and use lubricant drops, as screens reduce blinking.
• Exercise: Gentle walking straight away; light gym work after about a week; contact sports once your surgeon is happy with healing.
• Bathing and face washing: Keep water and soap out of your eyes for the first week, and avoid eye make-up until advised.

PRK vs LASIK and SMILE: Results and Success

Long-term visual results after PRK are broadly the same as after LASIK for suitable prescriptions. The difference is in the journey, not the destination:

• PRK: No flap; slower recovery (about a week to function, weeks to months to full sharpness); more discomfort early on; small risk of corneal haze, more relevant at higher powers.
• LASIK: Flap; vision usually good within a day; very little discomfort; flap-related precautions.
• SMILE: Small keyhole incision, no flap; vision settles over a few days; limited mainly to short-sightedness with or without astigmatism.

As with any laser procedure, a small residual power can remain, and an enhancement is occasionally needed once the eye has stabilised. PRK is also one of the standard ways of performing that enhancement after other procedures.