SMILE surgery (Small Incision Lenticule Extraction)
What Is SMILE Surgery?
During SMILE, we use a femtosecond laser to create a small, lens-shaped piece of tissue inside your cornea called a lenticule. This lenticule has the exact thickness needed to correct your prescription. We then remove it through a small opening, which changes the curvature of your cornea and focuses light properly on your retina.
By removing the lenticule, your cornea becomes flatter and light rays bend correctly, giving you clearer vision without glasses. The laser works with incredible precision, customized to your unique eye measurements.
SMILE is designed primarily to treat myopia, or nearsightedness, in people who have trouble seeing distant objects clearly. We can also correct myopic astigmatism, which means your cornea has an irregular shape that blurs vision at all distances. The procedure works best for low to moderate prescriptions, though advances continue to expand the range.
Currently, SMILE is not approved for farsightedness or presbyopia, the age-related loss of near vision. If you have these conditions, we may recommend alternative vision correction options.
One major advantage of SMILE is the tiny opening we use to remove the lenticule. The incision is usually only two to four millimeters long, much smaller than the flap created in traditional LASIK. This small access point helps preserve more of the cornea's structural integrity and nerve fibers.
- Less disruption to corneal nerves, which may reduce dry eye symptoms
- Lower risk of flap-related complications because no large flap is created
- Greater corneal stability after surgery, which matters for contact sports or active lifestyles
- Faster healing of the surface since the incision is so small
LASIK involves creating a hinged flap on the cornea, lifting it, reshaping the tissue underneath with a second laser, and then replacing the flap. SMILE skips the flap step entirely by working inside the cornea and using only one laser. PRK removes the surface layer of the cornea completely before laser reshaping, leading to a longer, sometimes more uncomfortable recovery.
All three procedures can deliver excellent vision, but SMILE may offer benefits for people concerned about dry eyes or those with demanding physical activities. Our eye doctor will help you weigh the pros and cons of each method based on your prescription, corneal thickness, lifestyle, and overall eye health.
Determining If SMILE Is Right for You
The best SMILE candidates are adults over 18 whose prescriptions have been stable for at least one year. You should be in good overall health and free from active eye infections or certain chronic eye diseases. Most people seeking SMILE have moderate nearsightedness with or without astigmatism and prefer an option that involves minimal corneal disruption.
If you lead an active lifestyle, participate in contact sports, or work in environments where eye trauma is possible, SMILE may be especially appealing because it strengthens corneal stability. We also consider your corneal thickness, pupil size, and tear film quality during our evaluation.
Certain eye conditions can make SMILE less safe or less effective. Keratoconus, a condition where the cornea thins and bulges, is typically a disqualifier because the cornea is already weakened. Advanced glaucoma, uncontrolled diabetes that affects the retina, or cataracts may also rule out SMILE until those issues are managed.
- Active eye infections or inflammation that need treatment first
- Thin corneas that do not leave enough tissue after lenticule removal
- Severe dry eye syndrome that could worsen after surgery
- Unstable prescriptions that continue to change year to year
We review your full medical history, including autoimmune diseases like lupus or rheumatoid arthritis that can affect healing. Pregnancy and breastfeeding cause hormone fluctuations that temporarily change your prescription, so we typically recommend waiting until afterward. Certain medications, such as isotretinoin for acne or long-term steroids, may also impact your candidacy.
Your hobbies and career matter too. If you are a pilot, military service member, or professional athlete, we discuss how SMILE recovery and outcomes align with your specific requirements. Clear communication about your goals and daily life helps us tailor our recommendations.
Before SMILE, we perform a comprehensive eye exam that goes beyond a standard vision screening. This includes detailed corneal mapping with a topographer to measure the shape and thickness of your cornea at thousands of points. We also measure your pupil size in dim light, check your tear production, and assess the overall health of your retina and optic nerve.
These tests allow us to create a personalized treatment plan and confirm that SMILE is safe for your eyes. We use the measurements to program the laser precisely, ensuring the lenticule has the exact dimensions needed to correct your vision. You will stop wearing contact lenses for a period before these tests to let your corneas return to their natural shape.
What to Expect During SMILE Surgery
On the day of surgery, eat a light meal and take any medications our eye doctor approves. Avoid wearing makeup, perfume, or cologne, as these can interfere with the laser or increase infection risk. Arrange for someone to drive you home because your vision will be blurry immediately after the procedure and we use numbing drops that affect your eyes.
Wear comfortable clothing and bring sunglasses to protect your eyes from bright light on the way home. We will provide final instructions and answer any last-minute questions before you enter the laser suite.
Once you are settled in the reclining chair, we apply numbing drops to your eyes so you will not feel pain. A small device gently holds your eyelids open to prevent blinking. You will be asked to focus on a blinking green light while the laser does its work, which takes only seconds per eye.
- The femtosecond laser creates the lenticule and the small incision inside your cornea
- You may feel light pressure and notice your vision dim briefly as the laser operates
- Our eye doctor carefully loosens and removes the lenticule through the tiny opening
- No stitches are needed because the incision is so small it seals on its own
- We rinse your eye with a sterile solution and check that everything looks perfect
The laser portion of SMILE lasts only about 25 seconds per eye. The entire process, including preparation, positioning, and post-laser checks, typically takes 10 to 15 minutes for both eyes. Even though it is quick, we work carefully to ensure accuracy and comfort at every step.
After we finish, you will rest briefly while we review your initial recovery instructions. Most patients are surprised at how fast the procedure goes and how little discomfort they feel during it.
SMILE uses topical anesthetic eye drops rather than injections, so you remain awake and aware throughout the procedure. The numbing drops work quickly and prevent pain, though you may sense pressure or a feeling of something touching your eye. Many patients describe the experience as easier than they expected.
If you feel anxious, let us know in advance. We may recommend a mild oral sedative to help you relax, though most people do well with reassurance and clear communication. Our team talks you through each step so you know exactly what is happening.
Recovery and Caring for Your Eyes After SMILE
Your vision will be blurry and hazy right after SMILE, and your eyes may water, burn, or feel gritty. These sensations are normal and usually improve within a few hours. We recommend going home to rest in a dim room with your eyes closed as much as possible, which helps the initial healing.
Avoid rubbing your eyes, even if they feel itchy, because this can disturb the incision. Wear the protective eye shields we provide while you sleep to prevent accidental rubbing. Most people notice significant vision improvement by the next morning, though it continues to sharpen over the following days.
During the first week, your vision will fluctuate as your eyes heal. You may see halos around lights at night or experience mild dryness. By the end of week one, many patients can return to work and most daily activities, though you should still avoid strenuous exercise and swimming.
- Week two to four: Vision continues to stabilize, and side effects like dryness and glare steadily decrease
- Month two to three: Most people reach their final vision outcome, though minor improvements can continue
- Month three to six: Your eyes are fully healed, and any residual dryness typically resolves completely
We will prescribe antibiotic eye drops to prevent infection and anti-inflammatory drops to reduce swelling. You will use these several times a day for the first week or two, following the exact schedule we provide. In 2025, most patients also use preservative-free artificial tears frequently to keep the eyes moist and comfortable during healing.
It is important to wash your hands before applying drops and avoid touching the dropper tip to your eye or any surface. If you have trouble remembering your drop schedule, set alarms on your phone or keep a written log. Proper use of medications supports a smooth, complication-free recovery.
For the first week, skip swimming, hot tubs, and saunas to reduce infection risk from water exposure. Avoid heavy lifting, contact sports, and vigorous workouts that raise eye pressure or risk trauma. You can shower and wash your face gently, but keep soap and water out of your eyes.
Wait at least two weeks before wearing eye makeup, and replace old mascara and eyeliner to avoid contamination. Protect your eyes from dust and wind by wearing sunglasses outdoors. Most people can resume all normal activities, including demanding sports, around four weeks post-surgery, but confirm timing with our eye doctor at your follow-up visits.
We will schedule your first follow-up appointment within one to two days after SMILE to check your healing and vision progress. Additional visits typically occur at one week, one month, three months, and six months. During these appointments, we measure your vision, examine the incision site, and ensure no complications have developed.
If you experience any unusual symptoms between visits, contact us right away rather than waiting for your next scheduled appointment. Regular monitoring helps us catch and address any issues early, giving you the best possible outcome. Long-term, we recommend annual comprehensive eye exams to maintain your overall eye health.
Outcomes, Side Effects, and When to Seek Care
Most SMILE patients achieve 20/20 vision or better, and many notice dramatic improvement within the first day. Your vision will continue to refine over the first three months as your cornea fully heals and stabilizes. The goal is to reduce or eliminate your dependence on glasses and contacts for distance vision.
While outcomes are generally excellent, a small percentage of people may need an enhancement procedure if their vision does not fully correct or if a minor prescription remains. Our eye doctor will discuss realistic expectations based on your specific prescription and eye characteristics before surgery.
Temporary side effects are common as your eyes adjust after SMILE. Dry eyes are the most frequent complaint, though they are usually less severe than with LASIK due to the smaller incision. You may also notice halos, glare, or starbursts around lights, especially at night, which typically fade as healing progresses.
- Mild fluctuations in vision clarity from day to day or even hour to hour
- Light sensitivity that improves with sunglasses and gradually resolves
- A feeling of grittiness or a foreign body sensation in the first few days
- Slight redness or bloodshot appearance that clears within a week or two
Although SMILE is very safe, all surgical procedures carry some risk. Infection is rare but possible, which is why we prescribe antibiotic drops and stress good hygiene. Undercorrection or overcorrection can occur if the lenticule does not provide the exact amount of change needed, though enhancements can often fine-tune the result.
Other uncommon complications include irregular astigmatism if the lenticule is not removed smoothly, persistent dry eye that requires long-term management, or corneal haze that affects vision quality. Serious vision-threatening complications are extremely rare. We take every precaution to minimize risks, and our advanced technology and experience contribute to high safety rates in 2025.
Contact our eye doctor or seek urgent care right away if you experience sudden vision loss, severe eye pain that does not improve with over-the-counter pain relief, or intense redness and discharge that suggests infection. Flashes of light, new floaters, or a curtain-like shadow over your vision could indicate a retinal problem unrelated to SMILE that still needs emergency evaluation.
If you suffer any trauma to your eye after SMILE, even if it seems minor, call us immediately. Prompt attention to warning signs helps protect your vision and allows us to intervene quickly if a complication arises.
Frequently Asked Questions
SMILE permanently reshapes your cornea, so the correction itself does not reverse. However, your eyes can still change over time due to natural aging processes like presbyopia, which affects near vision after age 40, or conditions such as cataracts. Changes unrelated to the original nearsightedness or astigmatism may mean you need reading glasses or other vision aids later in life.
Yes, we typically perform SMILE on both eyes during the same appointment, which is the standard approach in 2025. Treating both eyes together allows for a single recovery period and faster return to normal activities. Some patients prefer this because they avoid the imbalance of having one corrected eye and one uncorrected eye during healing.
If you are under 40, SMILE corrects your distance vision, and you should not need reading glasses for close-up tasks. Once presbyopia begins, usually in your mid-40s, nearly everyone needs help with near vision regardless of whether they had SMILE. We can discuss options like monovision, where one eye is set for distance and the other for near, though this is not the standard SMILE approach.
Many patients can drive within a day or two once their vision is clear enough to meet legal requirements and they feel comfortable behind the wheel. Returning to work depends on your job and how your eyes feel. Desk jobs are often possible after one to three days, while positions involving heavy physical labor, dust, or chemicals may require a week or more off.
If your prescription drifts over time due to natural eye changes, we can evaluate whether an enhancement procedure is appropriate. Some patients are good candidates for a second laser treatment to refine their vision, while others may simply use glasses for specific tasks. Regular eye exams help us monitor any changes and recommend the best course of action to keep your vision sharp.
Getting Help for SMILE surgery (Small Incision Lenticule Extraction)
If you are considering SMILE or have questions about whether it is right for you, schedule a comprehensive consultation with our eye doctor. We will evaluate your eyes, discuss your vision goals, and explain all your options in detail so you can make an informed decision. Our team is here to support you through every step of your vision correction journey.