Laser Iridotomy Procedure: Benefits and Risks

Glaucoma does not always develop because the eye produces too much fluid. In some people, the natural drainage angle between the iris and cornea becomes unusually narrow or closes, preventing aqueous humour from leaving the eye normally. This can cause intraocular pressure to rise and may damage the optic nerve if the pressure remains uncontrolled.

Laser iridotomy is a procedure used mainly for eyes with narrow or closed drainage angles. It creates a very small opening in the peripheral iris, allowing fluid to move more freely within the eye and helping relieve the pressure mechanism responsible for angle closure.

At Surya Eye Hospital, laser iridotomy is available as part of glaucoma management. Assessment before treatment helps determine the type of glaucoma, drainage-angle anatomy and whether laser treatment is appropriate for the individual patient.

What is Laser Iridotomy?

Laser iridotomy, also called laser peripheral iridotomy or LPI, is a procedure that creates a tiny opening in the iris. This opening helps fluid move more freely inside the eye and can reduce pressure caused by a narrow or closed drainage angle.

In some people, fluid cannot pass normally through the pupil, causing pressure to build behind the iris. This can push the iris forward and narrow the drainage angle.

During the procedure, an ophthalmologist uses a laser to make a small opening in the outer part of the iris. This helps balance pressure inside the eye and may allow the drainage angle to open. Laser iridotomy is mainly used for angle-closure conditions caused by pupillary block.

Why is Laser Iridotomy Recommended?

Laser iridotomy is recommended when an ophthalmologist identifies a significant risk of angle closure or confirms that angle closure is already affecting the eye. Its main purpose is to relieve the pupillary-block component that can obstruct aqueous-fluid drainage.

An ophthalmologist may consider laser iridotomy in situations such as:

• Primary angle closure: The drainage angle has become partly or completely obstructed, sometimes with raised eye pressure.
• Primary angle-closure glaucoma: Angle closure is accompanied by glaucomatous optic-nerve damage.
• Acute angle closure: Laser treatment may be performed after the immediate rise in eye pressure has been medically controlled and the cornea is clear enough for treatment.
• The other eye after an acute attack: The fellow eye may have similar anatomy and may require preventive treatment after assessment.
• Selected narrow-angle eyes: Some people have narrow drainage angles without glaucoma. Their need for treatment depends on individual risk rather than angle appearance alone.

How is the Laser Iridotomy Procedure Performed?

Laser iridotomy is usually performed as an outpatient procedure. The eye is examined before treatment, the laser is used to create a tiny opening in the iris, and eye pressure is checked afterward.

• Eye examination: The ophthalmologist checks the eye and measures intraocular pressure. Gonioscopy may also be used to assess the drainage angle.
• Eye drops before treatment: Drops may be given to constrict the pupil. In some patients, pressure-lowering medicine may also be used before the laser.
• Anaesthetic drops: Numbing eye drops are applied to reduce discomfort during the procedure.
• Contact lens placement: A special contact lens is placed on the eye to help focus the laser accurately.
• Laser treatment: The ophthalmologist directs laser energy at the peripheral iris to create a very small opening. This allows aqueous humour to move more freely and helps reduce pressure differences across the iris.
• Pressure check after treatment: Eye pressure is usually measured again because it may rise temporarily after laser iridotomy.
• Post-procedure medicines: Anti-inflammatory eye drops may be prescribed for a short period.
• Follow-up: The ophthalmologist checks whether the opening remains clear and whether the drainage angle has widened adequately. Further treatment may be needed if eye pressure remains high.

Benefits of Laser Iridotomy

The main benefit of laser iridotomy is that it addresses pupillary block, an important mechanism behind several forms of angle closure. By creating another route for fluid movement, the procedure can reduce pressure differences that cause the iris to obstruct the drainage angle.

Potential benefits include:

• Relieving pupillary block: The new opening allows fluid to bypass resistance at the pupil.
• Helping widen the drainage angle: Equalising pressure across the iris may allow it to move backward and expose more of the drainage angle.
• Reducing the risk of another acute angle-closure episode: This is particularly relevant after treatment of an acute attack.
• Protecting the fellow eye when appropriate: Preventive treatment may be recommended when the second eye has high-risk anatomy.
• Avoiding a conventional surgical incision: Treatment is delivered with laser energy through the surface of the eye.
• Allowing further glaucoma management: Once pupillary block has been relieved, the ophthalmologist can better assess whether additional pressure-lowering treatment is required.

However, laser iridotomy does not restore sight already lost from glaucoma. It also does not necessarily improve normal vision in an otherwise symptom-free eye. Its purpose is primarily to improve fluid movement and reduce the risk associated with angle closure.

Possible Risks and Side Effects of Laser Iridotomy

Laser iridotomy is generally well tolerated, but it can cause temporary side effects and, less commonly, complications. Patients should understand both the expected short-term effects and the symptoms that require further assessment.

What to Expect After Laser Iridotomy

Most patients can go home after a short observation period and an eye-pressure check. Mild blurred vision, irritation or brow discomfort may occur for a few hours after the procedure.

• Use prescribed eye drops: Anti-inflammatory or pressure-lowering drops should be used for the recommended duration.
• Attend follow-up visits: The ophthalmologist checks whether the laser opening remains clear and whether the drainage angle has widened.
• Avoid driving immediately afterward: Vision may remain temporarily blurred because of the laser, contact lens and eye drops used during treatment.
• Resume routine activities gradually: Most daily activities can be restarted based on the ophthalmologist’s advice and how the eye feels.
• Continue glaucoma medicines if prescribed: Do not stop existing glaucoma treatment unless the eye specialist specifically advises a change.

Does Laser Iridotomy Cure Glaucoma?

No. Laser iridotomy treats an important anatomical mechanism behind angle closure, but it does not cure glaucoma or reverse optic-nerve damage that has already occurred.

Some patients achieve satisfactory pressure control after the angle opens. Others may continue to have elevated intraocular pressure because of permanent drainage-angle damage, extensive adhesions, plateau iris configuration or another glaucoma mechanism.

In such cases, treatment may still involve glaucoma eye drops, further laser procedures, lens surgery or glaucoma surgery. Continued monitoring of intraocular pressure, the optic nerve and visual fields remains important even after a successful iridotomy.

When Should You Contact an Eye Specialist After the Procedure?

Mild blur or discomfort may occur after laser iridotomy, but significant or worsening symptoms require medical assessment. Patients should follow the specific warning signs provided by their treating ophthalmologist.

Seek prompt eye care if you develop:

• Significant or increasing eye pain
• Sudden or marked reduction in vision
• Severe or persistent headache
• Increasing redness or swelling
• Nausea or vomiting with eye pain
• Visual symptoms that become severe or continue longer than expected

These symptoms do not necessarily mean that a serious complication has occurred, but they should be assessed rather than managed at home without advice.

FAQs

Is laser iridotomy painful?

Laser iridotomy is usually performed after anaesthetic eye drops are applied. Patients may notice brief discomfort, pressure or a snapping sensation during laser delivery. Mild irritation, brow ache or headache can also occur for several hours after treatment.

How long does it take to recover after laser iridotomy?

Vision may remain slightly blurred for several hours after laser iridotomy, while mild irritation can last longer. Most people resume routine activities relatively quickly, but recovery advice depends on the eye's response and the ophthalmologist's examination.

Can eye pressure rise after laser iridotomy?

Yes. Intraocular pressure can temporarily increase after laser iridotomy because pigment, blood or inflammatory material may affect drainage. Eye pressure is therefore commonly checked after treatment, and pressure-lowering medication may be prescribed when clinically necessary.

Can the opening created by laser iridotomy close again?

Yes, although many laser openings remain patent long term. Iris pigment or tissue can occasionally obstruct or narrow the opening. Follow-up examination helps confirm that it remains open, and repeat laser treatment can be performed if necessary.

Will I still need glaucoma eye drops after laser iridotomy?

Possibly. Laser iridotomy relieves pupillary block but does not address every cause of elevated eye pressure. Patients with established angle-closure glaucoma or persistent pressure elevation may continue glaucoma medicines or require another laser or surgical treatment.