Laser iridotomy

Laser iridotomy is a medical procedure that uses laser energy to create a small opening in the iris of the eye. The purpose of this opening is to improve the flow of aqueous humor, the fluid inside the eye, between the posterior and anterior chambers. This helps to alleviate a specific mechanism of drainage blockage within the eye. This procedure is considered an effective treatment for particular conditions related to the eye's drainage angle.

Laser iridotomy is primarily indicated for patients with a narrow or closed drainage angle, a condition that can lead to angle closure glaucoma. Angle closure glaucoma can be acute, involving a sudden and significant rise in intraocular pressure, or chronic, with gradual angle closure. The treatment may also be performed preventatively in the other eye if it is deemed at risk for angle closure. It is important to understand that iridotomy is not suitable for all types of glaucoma.

Before the procedure, eye drops may be administered to lower pressure or constrict the pupil, which helps to stretch the iris and facilitate opening creation. Local anesthetic drops are then applied to the eye. During the procedure, the patient sits in front of a laser machine, and a special contact lens is placed on the eye to focus the laser beam, prevent blinking, and reduce eye movements. The laser then creates a tiny, pinhole sized opening in the iris. The entire procedure typically lasts only a few minutes.

The opening allows aqueous fluid to move from the space behind the iris to the anterior chamber without passing through the pupil. This relieves pupil block, which can otherwise push the iris forward and close the drainage angle. It is not a passage from the vitreous cavity at the back of the eye.

Iridotomy reduces the risk from this mechanism but does not always normalize pressure or fully open an angle that has other causes of narrowing or permanent scarring. Drops, lens surgery or other treatment may still be needed. The aim is to protect remaining vision, not reverse existing optic nerve damage.

No special preparation is usually required beyond following the medical team's instructions. You may be advised to arrange for someone to accompany you. Risks associated with laser iridotomy are rare and include mild eye inflammation, minor bleeding in the iris, a temporary rise in intraocular pressure, or a sensation of glare due to light passing through the new opening. In some cases, creating the opening may be challenging, or the opening might close, requiring a repeat procedure. The risk of vision loss due to this procedure is very low.

After the procedure, you might experience mild blurry vision, a dull headache, slight redness, or light sensitivity for a few days. Most individuals can resume normal activities the following day. You may be prescribed anti inflammatory eye drops or pressure lowering drops for a short period. It is crucial to attend follow up appointments to ensure the opening remains patent, intraocular pressure is stable, and the angle remains open. Follow your medical team's instructions regarding the schedule for these check ups.

Even after treatment, it is important to be vigilant for changes in your eye's condition. If you experience sudden and severe eye pain, significant redness, marked blurry vision, nausea, or vomiting, you should seek urgent medical attention. These symptoms could indicate a sharp rise in intraocular pressure or another complication, requiring immediate assessment.