What Is the PRK Surgery Procedure Like? | Lasik Awards

Quick Answer

PRK surgery takes approximately 10–15 minutes per eye and is entirely painless due to topical anesthetic drops. The surgeon removes the corneal epithelium, the excimer laser reshapes the stroma for 30–90 seconds, a bandage contact lens is placed, and you are done. Patients are awake throughout and may see blurred lights and smell a faint burning odor during the laser portion — both are normal.

Detailed Explanation

Knowing exactly what to expect during PRK surgery eliminates the anxiety that comes from uncertainty. Here is a detailed, step-by-step account of the procedure from the moment you arrive to the moment you leave.

Arrival and Pre-Procedure Preparation (30–60 minutes)

You will arrive at the surgical center approximately 30–60 minutes before your scheduled procedure. During this time:

Identity and prescription verification: Your prescription, measurements, and consent documents are reviewed.
Pre-operative drop administration: Antibiotic drops may be applied before surgery. If you are anxious, your surgeon may offer a mild oral sedative (typically diazepam or lorazepam) — ask about this in advance.
Surgical marking: For astigmatism correction, the surgeon may mark your eye with a small ink marker while you are sitting upright, as eye position shifts when lying down.
Sterile gown and hair covering: Standard surgical preparation.

You will be escorted to the laser suite and positioned lying flat on the laser bed.

Step 1: Topical Anesthesia (Minutes 0–2)

Anesthetic eye drops (typically proparacaine or tetracaine) are applied directly to the corneal surface. These drops numb the cornea within 30–60 seconds. You will feel no pain during the procedure, though you may feel some pressure sensations. The drops are reapplied as needed throughout the procedure.

A lid speculum — a small, smooth instrument — is gently placed to hold your eyelids open so you do not need to worry about blinking. Most patients find this mildly uncomfortable but not painful.

Step 2: Epithelial Removal (Minutes 2–5)

The surgeon removes the corneal epithelium — the outer protective cell layer — using one or more of these techniques:

Alcohol-assisted removal (LASEK variant): Dilute alcohol (20% ethanol) is applied for 20–30 seconds to loosen the epithelium, which is then gently wiped away with a surgical sponge.
Mechanical removal (mechanical PRK): The surgeon uses a flat blade or Amoils brush to mechanically debride the epithelium without alcohol.
Trans-PRK / SMART surface: The laser itself ablates the epithelium in the first pass before reshaping the stroma.

This step takes approximately 1–3 minutes. You may feel slight pressure and your vision will become immediately blurry as the epithelium is removed.

Step 3: Laser Ablation (Minutes 5–7)

You will be asked to fixate on a blinking green or orange fixation light directly above you. This is the most important thing you do during the procedure — maintain focus on that light. Modern laser systems have active eye-tracking that compensates for small, involuntary eye movements, but gross deviation from the fixation target affects the result.

The excimer laser fires in short pulses, each removing microscopic amounts of corneal tissue. During this phase:

You will hear a rapid clicking or popping sound — the laser firing
You may smell a faint burning or antiseptic odor — vaporized corneal tissue. This is normal and does not indicate a problem.
Vision blurs further as the stroma is reshaped
Duration: 30–90 seconds per eye, depending on your prescription magnitude

You will feel no pain. The procedure is complete before most patients realize the laser has stopped.

Step 4: Mitomycin-C Application (Minutes 7–9)

For most PRK cases, the surgeon applies a small sponge soaked in mitomycin-C (MMC) solution to the corneal surface for a precisely timed interval (typically 12–30 seconds). MMC suppresses fibroblast activity to prevent clinically significant corneal haze during healing.

The area is then thoroughly rinsed with chilled saline to remove all MMC before proceeding.

Step 5: Bandage Contact Lens Placement (Minutes 9–10)

A soft, clear bandage contact lens is placed over the eye. This lens does not contain prescription — its purpose is to protect the exposed epithelial bed and significantly reduce discomfort during healing. It remains in place until the epithelium regenerates, typically 4–5 days, at which point your surgeon removes it at a follow-up visit.

The speculum is removed. You have completed one eye.

The Second Eye

After a brief pause, the process repeats for the second eye. Total table time for both eyes is typically 15–30 minutes.

Immediately After Surgery

You will be escorted to a recovery area for 15–30 minutes. Vision is significantly blurred. Anesthetic drop effect begins to wear off within 60–90 minutes, at which point discomfort begins to build. You must have a driver — you cannot drive yourself home. Most surgeons recommend going directly home and resting.

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Important Considerations

Keep your eye on the fixation light. This is your one active responsibility during surgery. If you feel you are losing it, say so — the surgeon can pause.

The sounds and smells are normal. Many patients are surprised by the clicking sound and burning odor. These are byproducts of the laser mechanism and do not indicate complications.

The procedure moves faster than most patients expect. The laser ablation phase is often 45 seconds or less for moderate prescriptions. Some patients cannot believe it is over.

You may feel pressure but not pain. If at any point you feel genuine pain during the procedure — not just pressure — tell your surgeon immediately. Re-application of anesthetic drops takes seconds.

What to Do Next

1. Prepare your home environment before surgery day. You will not be productive the evening of surgery. How Do I Prepare for PRK Surgery covers the complete preparation checklist.

2. Arrange a driver. This is non-negotiable — not a suggestion.

3. Ask your surgeon about the sedation option. If you are anxious about the procedure, a mild oral sedative administered before surgery is commonly available and dramatically reduces procedural anxiety.

4. Know the recovery arc. The procedure ends when you leave the table — recovery begins. How Long Does PRK Recovery Take covers every phase.