Laser Iridotomy is an outpatient procedure used in ophthalmology to address specific pressure issues within the eye. This procedure uses targeted laser energy to create a tiny, permanent opening in the colored part of the eye, known as the iris. The primary goal is to improve the flow of fluid inside the eye, which helps to regulate intraocular pressure. This intervention is often performed in a doctor’s office and typically takes only a few minutes to complete.
Why This Procedure is Necessary
The eye naturally produces a clear fluid called aqueous humor, which fills the space between the lens and the cornea, providing nourishment to the eye’s internal structures. This fluid must continuously drain out of the eye through a meshwork located in the angle between the iris and the cornea, maintaining balanced internal pressure. When this drainage angle becomes narrowed or blocked, the aqueous humor cannot exit properly, and the intraocular pressure begins to build.
A condition known as narrow angles occurs when the space for fluid drainage is significantly reduced, placing a person at risk for angle-closure glaucoma. In this type of glaucoma, the iris is pushed forward, potentially blocking the drainage system entirely. This acute pressure spike can cause irreversible damage to the optic nerve, leading to permanent vision loss if not addressed immediately.
Laser iridotomy is primarily a prophylactic measure used to prevent an angle-closure attack. By creating a bypass for the fluid, the procedure relieves the pressure imbalance that pushes the iris forward and obstructs the drainage angle. This permanent opening helps to pull the iris back from the drainage structures, restoring a proper fluid pathway inside the eye.
How the Laser Treatment is Performed
Before the laser iridotomy begins, the patient receives several types of eye drops to prepare the eye for the procedure. Anesthetic drops are administered to numb the surface of the eye, ensuring the treatment is comfortable, while other drops, such as Pilocarpine, may be used to constrict the pupil. Constricting the pupil helps to stretch and thin the iris, making it easier for the laser to penetrate the tissue.
The patient is seated at a machine similar to the microscope used for routine eye examinations. The ophthalmologist then places a special contact lens directly onto the eye’s surface, which helps to stabilize the eye and magnify and focus the laser beam onto the peripheral iris. This specialized lens allows for precise targeting of the intended treatment area, which is usually placed high up on the iris so that the resulting opening is covered by the upper eyelid.
Most commonly, a Nd:YAG laser is used, delivering a rapid pulse of energy to create the tiny opening in the iris tissue. During the application of the laser, the patient may experience a brief flash of light and hear a faint clicking or popping sound as the energy is delivered. The entire process of laser application often takes less than ten minutes per eye. Immediately following the procedure, the eye pressure is checked again before the patient is released.
Managing Recovery and Potential Outcomes
The recovery period following laser iridotomy is typically brief, with most patients able to resume their normal daily activities almost immediately. Patients often experience some temporary side effects right after the procedure, including mild blurring of vision due to the eye drops and a slight sensitivity to light. These minor visual disturbances usually resolve within a few hours to a day after the treatment is completed.
A temporary increase in intraocular pressure is a known side effect that can occur shortly after the laser application. To counteract this, the ophthalmologist may prescribe anti-inflammatory or pressure-lowering eye drops for the patient to use for a few days following the procedure. Patients may also notice a mild headache or a dull ache above the brow, which usually responds well to common pain relievers.
Follow-up care is important, and a check-up is typically scheduled within a few days to a few weeks to monitor the eye pressure and the status of the new opening. Minor complications can include brief inflammation, or, rarely, a small amount of bleeding from the iris tissue. In a small percentage of cases, the laser opening may gradually close over time, requiring a repeat treatment to maintain the proper fluid dynamics. The laser iridotomy is performed to prevent future damage, and it does not typically improve vision that may have been lost before the procedure.