Laser peripheral iridotomy (LPI) is a non-invasive laser procedure performed on the eye. This outpatient treatment involves creating a tiny opening in the iris, the colored part of the eye. The primary aim of LPI is to improve the flow of fluid within the eye, helping to manage or prevent conditions related to elevated eye pressure. It represents a precise approach to address specific eye health concerns without traditional surgical incisions.
Conditions Treated by Laser Peripheral Iridotomy
LPI is primarily performed to treat or prevent narrow-angle glaucoma and acute angle-closure glaucoma. These conditions arise when the “angle,” the area where the iris and cornea meet, becomes too narrow or blocked. This anatomical configuration can obstruct the natural drainage of aqueous humor, the fluid that nourishes the eye, leading to a buildup of pressure inside the eye.
When fluid cannot drain properly, intraocular pressure (IOP) increases, which can damage the optic nerve and potentially result in permanent vision loss. LPI works by creating a small bypass in the iris, allowing aqueous humor to flow more freely from the posterior chamber to the anterior chamber. This action helps to widen the drainage angle, reducing pressure and preventing the iris from blocking the eye’s drainage system. The procedure is particularly important as a preventative measure for individuals with narrow angles, reducing their risk of an acute angle-closure attack.
How Laser Peripheral Iridotomy is Performed
The LPI procedure is conducted in a doctor’s office, making it a convenient outpatient treatment. Before laser application, the eye is prepared with numbing eye drops for comfort. Specific drops are also administered to constrict the pupil, which helps to stretch and thin the iris, making it easier for the laser to create the opening.
During the procedure, the patient sits at a specialized microscope, and a contact lens is gently placed on the eye. This lens helps the ophthalmologist maintain a clear view, focus the laser precisely on the iris, and keep the eye stable. A YAG laser delivers concentrated pulses of light to create a tiny, microscopic hole in the peripheral iris. The entire process is completed within 5 to 20 minutes per eye.
Patient Experience and Recovery
Patients experience a bright flash of light during the LPI procedure, sometimes accompanied by a mild sensation described as a “static shock” or a “zap.” Numbing drops prevent significant pain, though some mild discomfort can occur. Immediately following the procedure, temporary blurred vision, mild irritation, redness, or sensitivity to light are common, resolving within a few hours to a day.
Some individuals may develop a mild headache, often attributed to the eye drops used to constrict the pupil. Shortly after LPI, eye pressure is checked to monitor for any temporary elevation, which is a manageable side effect. Patients are prescribed anti-inflammatory eye drops for several days to a week to reduce inflammation and promote healing. While most can resume normal activities quickly, arranging transportation home is recommended due to temporary vision changes.
Long-Term Outlook After Laser Peripheral Iridotomy
LPI is generally effective in preventing future episodes of angle-closure glaucoma and in managing intraocular pressure. The small opening created in the iris is permanent, allowing for sustained improvement in fluid dynamics within the eye. LPI helps preserve vision by preventing optic nerve damage from high pressure, but it does not improve vision that has already been lost.
The procedure does not cure glaucoma, which is a chronic condition that often requires ongoing monitoring and, in some cases, additional treatments. A temporary increase in eye pressure can occur shortly after the procedure in a small percentage of patients, which is typically managed with additional eye drops. Rarely, the iridotomy may close over time, necessitating a repeat procedure. Uncommon visual disturbances, such as glare or “ghost images,” may be reported, which often diminish over time.