Laser Peripheral Iridotomy

What is Laser Peripheral Iridotomy?

During laser peripheral iridotomy, a laser makes 1 or 2 small holes through the iris (the colored part of the eye). This gives the fluid that normally circulates in the eye (the aqueous) an alternative pathway to the angle, where fluid drains out of the eye. This procedure is performed in several minutes as an outpatient in a surgery center.

Why is Laser Peripheral Iridotomy performed?

When the angle of the eye is narrow, there is a risk of angle closure glaucoma. Angle closure glaucoma is a sudden, painful, site-threatening condition caused by very high eye pressure. In most people with narrow angles, the laser will prevent angle closure glaucoma. If the angle is already closed, the laser may open the angle and lower eye pressure.

What should I expect during the laser? Does Laser Peripheral Iridotomy hurt?

The laser procedure is performed in a surgery center. You will be there for perhaps one and a half hours, but the procedure takes just several minutes. The procedure is performed while sitting at a slit lamp, like when having an eye exam. A temporary contact lens will be placed for a few minutes to help focus the laser light. Numbing drops will be used. Patients often describe a mild tapping during the laser but sharp pain is not common. When the contact lens is removed, vision can be blurry for about an hour because of an ointment used on the contact lens. Often you will be placed on eye drops for about a week to prevent inflammation. Sometimes, the laser needs to be repeated if the first treatment did not create large enough holes in the iris.

Will the laser affect my vision or eye pressure?

If the laser is done for narrow angles, it is not expected to lower eye pressure or improve vision, just prevent angle closure glaucoma. If your eye pressure is high from a closed or a very narrow angle, the eye pressure may drop afterward. If pressure is high, most people will need to use eye drops going forward, and some may need further surgery.

What are the risks?

Serious risks from this treatment are rare, but could include vision loss. A small amount of bleeding in the eye, temporary high pressure, or inflammation is common, and resolves within a few days. Depending on how light goes through the holes in the iris, in some situations you may experience glare or a halo. On occasion the contact lens may cause a scratch on the eye surface called a corneal abrasion, which would usually heal within several days. Your doctor has determined that the potential benefits of this procedure outway the potential risks, and that you are a good candidate.

Are there alternative treatments?

Removal of a cataract or the eye’s lens is another way to open the angle. Although this is effective, it is more invasive, thus carries more risk. This is a good choice if a cataract is present that limits vision.