Laser iridotomy (for glaucoma)

Before performing an iridotomy, the ophthalmologist may apply various types of eye drops. The first drop, pilocarpine, will make your pupil smaller. Another type of eye drop may be used a few hours after laser treatment to prevent an increase in intraocular pressure following the laser treatment or to treat intraocular pressure that has already increased. Other eye drops may be used to reduce inflammation.

The only type of anesthesia required for performing a laser iridotomy is anesthetic eye drops. Thus, the laser procedure should be painless. You may see a bright light, similar to the flash of a camera, from a distance. You may also feel a pinching sensation.

The doctor will then place a special contact lens on your eye to focus the laser light on the iris. This lens keeps your eyelids apart, so you do not blink during the treatment. It also reduces small movements of the eyes, so you do not need to worry about eye movement during the treatment. To protect the eye from scratching by contact lenses, a special gel is applied to its surface. This gel can remain on the eye for approximately 30 minutes, leading to blurred vision or a feeling of heaviness.

The procedure is performed in the medical practice and lasts approximately five minutes.  Laser iridotomy uses a highly concentrated beam of light to create a drainage channel through the iris.

Laser iridotomy does not require hospitalization.

After the treatment, your doctor may ask you to stay for a few hours to check your intraocular pressure and ensure that it has not increased. When you are safe, you will be sent home and you may be asked to use eye drops. The ophthalmologist will explain how to use it and when you need to be examined again.

In general, there are no activity restrictions after laser treatment. You can return immediately to your normal daily activities. It is advisable for someone to drive you home from the doctor’s practice. You can expect some redness in the eyes, sensitivity to light, and a scratchy feeling. All of these may last for a few days. You might have a slight headache later or on the night after the procedure.

The risk of losing vision as a result of a laser procedure is extremely low. The main risks of laser iridotomy are that your iris may be difficult to penetrate, requiring multiple treatment sessions. The other risk is that the incision in the iris may close. This happens less than one-third of the time. Once the hole remains open for six weeks, it is unlikely to close in the future. In addition, you may need medications or other treatments to keep your intraocular pressure sufficiently low. This additional treatment is necessary if there is damage to the trabecular meshwork prior to iridotomy or if you also have one of the other types of glaucoma.

Do not worry about the size of the incision in the iris; it is not visible at all. It is usually placed in an area of the iris that is covered by the upper eyelid. The size of the iridotomy is only that of a needle tip.

Complications of laser iridotomy may include:

• Blurred near vision (common).
• Swelling (of the cornea) of the iris.
• Bleeding
• Increased pressure in the eye.

Creating a laser iridotomy is both safe and effective. There are small risks, but the purpose of an iridotomy is to preserve your vision, not to improve it.

• Treat closed-angle glaucoma after the pressure in the affected eye has been reduced with medication or when medications fail.
• Prevent closed-angle glaucoma in individuals who have narrow drainage angles and in those who have had closed-angle glaucoma in the other eye.

Laser iridotomy can prevent further episodes of sudden (acute) closed-angle glaucoma and also slow-forming closed-angle glaucoma in individuals at risk for closed-angle glaucoma.