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This Health Fact for You talks about laser iridotomy and when it’s needed.
Narrow Angle
Normally, an eye is filled with a fluid that nourishes the eye and helps it keep its shape. The fluid drains through the “angle”—part of the eye. The angle is located between the iris (the colored part of the eye) and the cornea (the clear part that covers the front of the eye).
The pressure in the eye is based on the difference between how much fluid is made and how much drains from the eye.
For some patients, the iris and the cornea are close together forming a narrow angle.
A narrow angle is at risk of closing, often when the pupil is dilated. This can happen by itself or be caused by medicine.
Peripheral Laser Iridotomy
You can have a laser procedure to prevent the angle from closing. A laser iridotomy is safe and effective, with few risks. A small hole is made in the edge of the iris to create a new drainage path for the eye fluid. The hole is about the size of a pinhead. Once this hole is made, it is very rare to have an angle-closure attack.
This treatment will greatly lower your risk of having a glaucoma attack.
Glaucoma Attack
There is no way to predict when or if you will have an attack. We can detect if you are at an increased risk. If you choose not to have this treatment, you need to know the risks and symptoms of angle closure so that you can seek treatment right away.
When the angle is closed, the drainage of fluid is sealed off. When the fluid cannot leave the eye, the pressure in the eye rises suddenly. As the pressure rises, the eye becomes red and painful. You may notice:
Blurred vision
Haloes around lights
Severe headache
Nausea
This is known as a "glaucoma attack" or acute angle‑closure glaucoma. This is an eye emergency.
An eye that has had an attack of angle‑closure may suffer from permanent:
Increased eye pressure
Vision loss
Blindness
Treatment
Your visit to the clinic for the peripheral iridotomy will begin with a pressure check. You will have several drops put in your eyes to prepare for the laser. One drop of pilocarpine will make your pupil smaller and the iris tissue more taut, like a drumhead. These drops can cause a slight headache that lasts for 20-30 minutes. The other drop will help to keep the eye pressure low during and after the treatment.
The laser treatment will be done after the drops have been in your eyes for about an hour.
You will sit at a machine that looks like the slit‑lamp microscope used for your eye exam in the clinic. The laser is attached to this machine.
We will put a drop of numbing medicine in your eye. The doctor will put in a special contact lens. You will focus on a target light in front of your other eye. Your doctor will “fire” the laser when you are in the correct position.
Most patients say that they feel a slight pop or shock when the laser is “fired,” but say that it is not painful.
Your doctor may push slightly on your eye with the contact lens if you have any bleeding in your eye.
Treatment takes only a few minutes for each eye that is treated.
We will give you a prescription for drops to be used for the next few days, 4 times a day.
Risks
One risk is that your iris might be thick enough that you may need more than one treatment session. The hole in your iris may scar and close. This may need to be opened again. There may be a small amount of bleeding in the eye after the treatment. This will be treated by the doctor putting pressure on the eye with the contact lens.
The laser could be fired at the wrong place in the eye, but this is very rare.
Your pressure may go up after the laser treatment for a short time. If this happens, we can use other medicines to bring down the pressure in your eye. Rarely, you may see glare or light reflections after treatment.
Activity
You will have no activity restrictions after your laser treatment.
Symptoms
You may notice symptoms after the procedure such as:
Slight blurring of vision because of the gel used with the contact lens.
Slight redness or a scratchy feeling in the treated eye for a few days
Light headache after the laser treatment
When to Call
Call the clinic if you have:
A sudden loss of vision
Pain beyond what was described
Any questions or concerns
Who to Call
University Station Eye Clinic
Monday through Friday
8 am to 4:30 pm
(608) 263-7171
When the clinic is closed, your call will be sent to the paging operator. Ask for the “eye resident on call.” Give your name and number with area code. The doctor will call you back.
The toll-free number is: 1-800-323-8942. Ask to be transferred to the above number.