Laser Iridotomy

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Laser iridotomy is a surgical procedure that is performed on the eye to treat angle closure glaucoma, a condition of increased pressure in the front chamber that is caused by sudden or slowly … Read More

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Laser Iridotomy

Laser iridotomy is one of the most effective laser procedure used to treat patients with glaucoma. It helps to treat patients with angle-closure glaucoma or a very narrow anterior chamber angle. The laser makes a small pinhead-sized hole in the top of the iris. Further, it improves the drainage of aqueous humor through the corner of the anterior chamber. This hole is hidden by the upper eyelid, due to which it is not visible externally. Laser iridotomy removes a functional pupillary block where the iris root blocks the drainage area. Due to a communication between the anterior and posterior chambers of the eye, the pressure in the chambers is equalized, which facilitates the opening of the angle of the anterior chamber of the eye and normalizes the circulation of intraocular fluid.

What is Glaucoma?

Glaucoma is a condition that causes damage to the optic nerve, resulting in impaired vision or blindness. The disease can occur at any age, starting at birth, but is most common in older people and older. Currently, there is no uniform understanding of the causes and mechanisms of the development of this disease. If glaucoma remains undetected for a long time, then the symptoms described below may subsequently appear. The main one is the deterioration of peripheral vision. A person sees well straight ahead, but objects located from the side and at an angle may not notice. At first, the narrowing of the field of vision occurs mainly from the side of the nose, and in the future, it can concentrically cover the peripheral parts up to its complete loss. The appearance of a translucent or opaque spot in the field of view is also possible. The patient may notice a decrease in dark adaptation, which consists of deterioration of vision during a rapid transition from a brightly lit room to a dark one, and also, sometimes, the appearance of color perception disorders.  Glaucoma can occur at any age; it mainly affects people over the age of 40. But this ailment can also affect young people (adolescent glaucoma) and even newborns (congenital glaucoma) since it most often develops in those whose parents also suffered from this ailment. Glaucoma can be an occupational disease; develops as a result of age-related changes, trauma, or concomitant diseases. Risk factors include:
  • age over 50
  • burdened heredity – the presence of glaucoma in close relatives;
  • wounds, eye contusions
  • chronic ophthalmic diseases such as cataracts, high myopia, iridocyclitis, chorioretinitis
  • the presence of hypertension, hypotension, diabetes mellitus, obesity
  • sclerotic changes in blood vessels or deposition of atherosclerotic plaques in them
  • cervical osteochondrosis, leading to a destruction of the innervation of the eyeballs.
Surgical intervention is indicated for open-angle glaucoma, poorly responding to the use of prescribed drugs. In an acute attack of angle-closure glaucoma, surgery is necessary if the intraocular pressure cannot be normalized with drug treatment.  Laser iridotomy is the removal of glaucoma without surgery. This type of treatment is highly effective, easily tolerated, and safe. Removal of glaucoma with a laser guarantees a complete cure for the disease. Laser iridotomy is performed without opening the eyeball and is a microsurgical intervention. The risk of complications is minimal.

What are the generally accepted indications of laser iridotomy?

Laser iridotomy is performed when a functional pupillary block angle-closure glaucoma. 
  • chronic glaucoma
  • closed glaucoma of the first and second types
  • an acute attack of glaucoma
  • with mixed glaucoma
  • preventive surgery
  • pathology of the anterior chamber angle – it may be too narrow or wide;
  • too much pigment
Laser iridectomy is not performed in patients with corneal edema and opacity or patients with a shallow anterior chamber. Despite the benefits of the procedure, it has various contraindications:
  • cataract
  • impaired transparency of the cornea
  • edema
  • the flat or shallow anterior chamber of the eye
  • paralytic mydriasis
  • neovascular glaucoma

Laser Iridotomy preparation

Before the procedure, the doctor prescribes a course of miotics – eye drops, which constrict the pupil. The also doctor prescribes a drug instillation, and if you avoid it, you will not achieve the desired post-treatment effect. These drops include, for example, Pilocarpine, which is often used by ophthalmologists during such operations.

The procedure is carried out in several stages:-

  • A doctor asks the patient to sit on a chair in a comfortable position. Your position is fixed so that the doctor can work with the eye. Then, you will have to sit motionless until the end of the procedure. Patients who cannot hold one position for a long time are not recommended to undergo the operation.
  • The patient is given local anesthesia. Drops are instilled to anesthetize the site of the operation for comfortable work on it. Then, Pilocarpine is also instilled to narrow the pupil and more conveniently work with the cornea. 
  • A specific device is applied to the human eye to improve visibility during the operation. It allows maximizing the area to be operated and adjust the direction of the laser.
  • Once the area is selected, the doctor focuses the laser on it and adjust the equipment accordingly. 
  • Through the lens, the beam passes into the eye tissues and makes a thin hole. It ensures the outflow of intraocular fluid.
  • The doctor may ask the patient to sit for some time before getting up – he should not make sudden movements immediately after the procedure.
On average, the operation takes 20-30 minutes. After the surgery, you may experience blurred vision for at least one hour, which later disappears. There is no doubt about the effectiveness and safety of laser iridotomy surgery.

Care and precautions after procedure

After the procedure, for several days or weeks, make sure you follow the guidelines as directed by the doctors. If you take proper care of your eye, your recovery will be fast, successful, and you won’t have to go back to the doctor. List of basic guidelines for patients undergoing laser iridotomy:
  • sleep on the side where the healthy eye is located
  • you cannot rub or press your eyes and avoid touching them with your hands;
  • prolonged stress: working at a computer, watching television, using a mobile phone, reading, knitting – should be minimized for the first couple of days to reduce eye strain
  • dirt, dust, and water should not enter the eyes
  • stop using cosmetics for eyelashes, eyelids, and eyebrows for a while
  • dark glasses in sunny weather are the best option for protection from direct sunlight
  • it is better to avoid mass gatherings, hospitals, clinics, and other places prone to possible infections.
  • do not carry weights, do not jump or run, avoid high physical exertion
  • bath and sauna are also prohibited; you cannot sunbathe
  • spicy and hot dishes should not be consumed, alcohol too
  • the drops prescribed by the doctor must be instilled on schedule

Benefits of laser iridotomy

  • the procedure allows you to restore the circulation of the aqueous humor of the eye in natural ways
  • it does not require special training, is performed on an outpatient basis, and has a minimum rehabilitation period
  • the intervention is carried out against the background of local anesthesia, which reduces the load on the cardiovascular system

Disadvantages of laser iridotomy

Like any surgical procedure, laser iridectomy has several disadvantages, including:
  • the limited effect, the ability to close the hole formed with the need for re-intervention
  • the possibility of damage to adjacent tissues (lens capsule, iris vessels) and formation of adhesions (synechia) in the iridotomy area

Laser iridotomy expected results

After the procedure, the recovery is quite fast, and you can felt noticeable results. If the condition (hole is overgrown) occurs again, you may need to repeat the surgery. Many ophthalmologists are decisive about the positive outcome of laser iridotomy. The operated person sees much better, the severity of seizures and complications during glaucoma decreases, and the risk of losing vision becomes minimal. Intraocular pressure is normalized, the patient’s quality of life improves. There is no other equally painless, fast, and relatively simple method at the moment. This option is one of the best to achieve an effect immediately with minimal cash costs.


· Severe eye pain.
· Nausea and vomiting.
· Headache.
· Blurred vision and/or seeing haloes around lights (Haloes and blurred vision occur because the cornea is swollen.)
· Profuse tearing.


· Acute angle-closure glaucoma is caused by a rapid or sudden increase in intraocular pressure (IOP), the pressure within the eye.
· Seek immediate medical for blurred vision, nausea, headache, and eye pain. Treatment involves laser therapy or surgery.