Learning About Laser Peripheral Iridotomy

Laser peripheral iridotomy is a procedure that uses a laser to make a tiny hole in the iris, the colored part of the eye.

This procedure is used to treat angle-closure glaucoma and may help prevent it in people at high risk. Angle-closure glaucoma happens when the eye’s drainage system becomes blocked. The procedure may also be used in people with narrow drainage angles, when the drainage space in the eye is smaller than normal.

In a healthy eye, fluid flows from behind the iris through the pupil (the black center) and then drains out. This flow helps keep eye pressure at a normal level.

When fluid gets trapped behind the iris and can't drain, pressure builds in the eye. High pressure can damage the optic nerve, which is what helps you see. If not treated, this pressure can lead to permanent vision loss. Creating a small hole in the iris allows fluid to bypass the blockage and drain out of the eye. This lowers eye pressure and helps protect vision.

This procedure is also done to treat an acute angle-closure attack, which can be painful and cause vision loss.

It is also done to prevent problems in people at risk, such as people with narrow drainage angles. Some people with narrow drainage angles may not need treatment right away. The decision to treat depends on your risk level and your doctor's advice.

Laser peripheral iridotomy may be suggested for people who have:

• Acute angle-closure glaucoma (a sudden blockage).
• Chronic angle-closure glaucoma (a slow narrowing over time).
• Narrow or blocked drainage angles in the eyes.
• Previously had angle-closure glaucoma in one eye and are at higher risk.
• A condition that makes fluid build up behind the iris. This is called a pupillary block.
• Other causes of blockage, such as uveitis, a type of eye inflammation.

Laser peripheral iridotomy is a quick outpatient procedure that takes about 5 to 10 minutes. It's usually done in a surgery center or an eye doctor’s office. You can go home the same day.

Before the procedure, eyedrops are given about 30 minutes before to make the pupil smaller. Numbing eyedrops are used to numb the eye, and other eyedrops are used to lower eye pressure.

During the procedure, a special lens is placed on the eye. A laser is used to make a tiny hole in the iris.

After the procedure, eye pressure is checked within a half hour to 2 hours. Eyedrops to reduce swelling may be given for a few days.

The procedure is generally safe. It can:

• Help fluid move normally in the eye.
• Lower eye pressure.
• Protect the optic nerve and vision.
• Prevent or treat acute angle-closure attacks, which can lead to vision loss.
• Be used as preventive treatment for people at risk.

Like any procedure, there are some risks. Side effects include:

• A short-term rise in eye pressure.
• Inflammation inside the eye.
• A small amount of bleeding where the laser was used.
• A headache or eye pain.

Serious but less common risks include:

• Glare, halos (light rings), or “ghost images" (double vision).
• Damage to nearby parts of the eye like the cornea, lens, or retina.
• Cataracts, or clouding of the eye's lens.

Sometimes the opening that was made can close over time, and the procedure may need to be repeated. In some cases, the procedure may not fully fix the problem if there is lasting damage to the part of the eye where fluid drains.

Soon after the procedure, your eye pressure will be checked. You may also get eyedrops to reduce swelling.

You may notice short-term symptoms, such as blurry vision, mild discomfort, and redness or sensitivity to light. You may also have a mild headache from the eyedrops.

Your doctor may schedule follow-up visits to check your eye health. You may have a gonioscopy, a test that looks at the eye's drainage angle. The doctor may also check your eye pressure and optic nerve.

Some people may need more treatment if the drainage angle stays narrow or eye pressure stays high. Regular checkups are important to watch for changes from glaucoma.