Laser Peripheral Iridotomy

Laser peripheral iridotomy is a preventive procedure that creates a tiny opening in the iris to reduce the risk of angle-closure glaucoma. This treatment is recommended for patients whose eye anatomy places them at risk of a sudden, painful rise in eye pressure.

Understanding Angle Closure Glaucoma

The eye continuously produces fluid (aqueous humour) that must drain through a structure called the drainage angle, located where the iris meets the cornea. In some eyes, particularly those that are naturally smaller or more farsighted, this angle can be narrow.

If the drainage angle closes suddenly, fluid cannot escape, causing eye pressure to rise rapidly. This is called acute angle-closure glaucoma-a medical emergency that can cause permanent vision loss within hours if untreated.

The National Eye Institute provides comprehensive information about glaucoma and its various forms.

Who May Benefit

Laser iridotomy may be recommended for:

• Narrow angles identified during routine eye examination

• Primary angle-closure suspect where anatomy suggests future risk

• Fellow eye protection if you have had angle closure in one eye

• Before cataract surgery in some patients with narrow angles

• Acute angle-closure glaucoma as part of emergency treatment

Risk factors for narrow angles include farsightedness, Asian or Inuit ethnicity, family history of angle-closure, and increasing age.

The Procedure

The procedure is performed at the slit lamp in the clinic:

• Anaesthetic drops numb the eye

• A special contact lens helps focus the laser

• The laser creates a small opening (about 0.5mm) in the peripheral iris

• Treatment takes approximately 5-10 minutes

• You may hear clicking sounds and see bright flashes

The American Academy of Ophthalmology explains how this opening allows fluid to flow more freely, reducing the risk of angle closure.

What Results Can Be Expected

Laser iridotomy is highly effective at preventing angle-closure attacks when the underlying cause is pupillary block. However, it does not treat existing glaucoma damage or guarantee that glaucoma will not develop from other causes. Ongoing monitoring remains important.

Potential Risks

• Temporary blurred vision for several hours after the procedure

• Mild discomfort or aching, usually brief

• Temporary pressure rise which is monitored after treatment

• Inflammation managed with anti-inflammatory drops

• Glare or visual symptoms are uncommon with proper placement of the opening

• Closure of the iridotomy may occur in some cases, requiring retreatment

• Bleeding at the iris during the procedure is usually minor and self-limiting

Medical Disclaimer: This information provides general guidance about laser peripheral iridotomy and should not replace professional medical advice. This procedure reduces but does not eliminate the risk of glaucoma, and ongoing monitoring is essential. Please consult with our ophthalmologists for assessment and recommendations based on your individual eye anatomy and risk factors.