Glaucoma: Laser Surgery on the Iris

What is laser iridotomy?

Laser iridotomy is a procedure to create a small hole in the colored part of the eye, called the iris, with a laser. This procedure helps treat or prevent angle-closure glaucoma.

Glaucoma is an eye disease in which the nerve that carries visual messages to the brain (optic nerve) is damaged. This is usually caused by high pressure inside the eye. Damage to the optic nerve can cause a permanent loss of vision. Glaucoma needs to be diagnosed and treated early to prevent blindness.

Normally, the fluid in the front of the eye is constantly flowing from where it is formed (the ciliary body) to the front of the eye. This fluid nourishes your eye and helps to keep its shape. The area between the iris (colored part of the eye) and the cornea (the clear outer layer on the front of the eye) is called the angle. Fluid drains out through the angle, into drainage channels, and is then reabsorbed by the body. When fluid flows out too slowly, eye pressure builds up.

In angle-closure glaucoma, the angle between the iris and the cornea is blocked or narrowed. When this happens, fluid is not able to drain from the eye. This can cause a pressure buildup.

When is it used?

Laser iridotomy helps restore the proper flow of fluid in the eye and reduce eye pressure. In most cases, this laser operation can successfully control eye pressure and preserve your vision. Without the procedure, you could permanently lose your vision.

If you have had an attack of angle-closure glaucoma, you may be in pain and may have nausea and vomiting in addition to sudden loss of vision. The iridotomy is done as an emergency procedure in these cases.

This procedure is also done in some people who are at high risk for getting angle-closure glaucoma. You may be at high risk if:

• You have narrow angles (where fluid flows out of the eye).
• You have had an attack of angle-closure glaucoma in one of your eyes but not the other.

Instead of this procedure, other treatments or procedures may include:

• having a different procedure
• taking medicine to help manage your symptoms

You may choose not to have treatment. Ask your healthcare provider about your choices for treatment and the risks.

How do I prepare for this procedure?

• Plan for your care and a ride home after the procedure.
• Some medicines (like aspirin) may increase your risk of bleeding during or after the procedure. Ask your healthcare provider if you need to avoid taking any medicine or supplements before the procedure.
• You may or may not need to take your regular medicines the day of the procedure, depending on what they are and when you need to take them. Tell your healthcare provider about all medicines and supplements that you take.
• Do not wear eye makeup on the day of the surgery.
• Follow any other instructions your healthcare provider gives you.
• Ask any questions you have before the procedure. You should understand what your healthcare provider is going to do. You have the right to make decisions about your healthcare and to give permission for any tests or procedures.

What happens during the procedure?

Your eye provider will put drops in the eye to lower pressure and keep you from feeling pain. Your provider may also put a special contact lens on the surface of the eye. A very short laser pulse will then be pointed at the eye. You may feel a quick pinch in your eye and hear a snapping noise. It is important to try to keep your head and eye still during the procedure and avoid jumping back. If you have an angle-closure glaucoma attack, this is an emergency procedure.

What happens after the procedure?

The provider will remove the contact lens and give you some steroid eyedrops. If this was an emergency procedure, it may take some time for your vision to return to its previous level and for the eye pressure to come back to a more normal level. In rare cases, another surgery is needed to control the eye pressure.

You will need a follow-up appointment to check your eye pressure and the results of the procedure.

You may need to have the same laser procedure in the other eye to prevent angle closure.

Ask your healthcare provider:

• how long it will take to recover
• what activities you should avoid
• how to take care of yourself at home and when you can return to your normal activities
• what symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup.

What are the risks of this procedure?

Your healthcare provider will explain the procedure and any risks. In general, the risks of laser iridotomy are small compared to its potential benefit. Some possible risks include:

• It is possible to develop a corneal scar and cataract after any laser procedure, which could limit your vision.
• The eye pressure can go up in some people, but this is usually temporary.
• Rarely, people develop blurry vision, double vision, or problems with glare after this procedure.

Every procedure or treatment has risks. Ask your healthcare provider how these risks apply to you. Be sure to discuss any other questions or concerns that you may have.