Glaucoma: Laser Iridotomy

What is laser iridotomy?

Laser iridotomy is a procedure used to help treat or prevent angle-closure glaucoma. The word angle in the term angle-closure refers to the connection between the iris (colored part of the eye) and the cornea (the clear outer layer on the front of the eye). This is where fluid drains from the eye. In angle-closure glaucoma, the iris has come forward towards the cornea, blocking the angle. The blockage prevents fluid from leaving the eye. This can cause a pressure buildup.

Laser iridotomy helps restore the proper flow of fluid in the eye and reduce eye pressure. The procedure involves creating a small hole in the iris with a laser.

When is it used?

If you have had an attack of angle-closure glaucoma, you may be in pain and may have nausea and vomiting in addition to sudden loss of vision. The iridotomy is done as an emergency procedure in these cases.

This procedure is also done in some people who are at high risk for getting angle-closure glaucoma. You may be at high risk if:

• You have narrow angles (where fluid flows out of the eye).
• You have had an attack of angle-closure glaucoma in one of your eyes but not the other.

What happens during the procedure?

Your eye surgeon will put drops in the eye to lower pressure and keep you from feeling pain. Your surgeon may also put a special contact lens on the surface of the eye. A very short laser pulse will then be directed at the eye. You may feel a quick pinch in your eye and hear a snapping noise. It is important to try to keep your head and eye still during the procedure and avoid jumping back. If you have an angle-closure glaucoma attack, this is an emergency procedure. In an emergency, you may need oral or IV medicine in addition to eye drops.

What happens after the procedure?

The provider will remove the contact lens and give you some steroid eyedrops. If this was an emergency procedure, it may take some time for your vision to return to its previous level and for the eye pressure to come back to a more normal level. In rare cases, another surgery is needed to control the eye pressure.

You will need a follow-up appointment to check your eye pressure and the results of the procedure.

You may need to have the same laser procedure in the other eye to prevent angle closure.

What are the benefits of this procedure?

In most cases, this laser operation can successfully control eye pressure and preserve your vision. Without the procedure, you could permanently lose your vision. If you are at high risk for an angle-closure glaucoma attack, laser iridotomy might prevent an attack from happening.

What are the risks associated with the procedure?

In general, the risks of laser iridotomy are small compared to its potential benefit. It is possible to develop a corneal scar and cataract after any laser procedure, which could limit your vision. A small amount of bleeding is fairly common and typically clears in a few days. The eye pressure can go up in some people, but this is usually temporary. Rarely, people develop blurry vision, double vision, or problems with glare after this procedure.

When should I call my eye care provider?

Contact your eye care provider if:

• You have severe pain.
• You have nausea or vomiting.
• You have a sudden decrease in vision.
• You see haloes around lights or objects.