Laser Iridotomy
Laser Iridotomy (LPI)
Laser Iridotomy, or Laser Peripheral Iridotomy (LPI), is a quick outpatient procedure used primarily to treat or prevent angle-closure glaucoma. By creating a microscopic hole in the outer edge of the iris, the procedure allows fluid to flow more freely between the back and front of the eye. This bypass balances internal pressure and prevents sudden, sight-threatening pressure spikes.
When You Should Consider Laser Iridotomy
Narrow-Angle Suspects: If a routine eye exam reveals that your drainage angles are naturally narrow, putting you at high risk for a sudden glaucoma "attack."
Acute Angle-Closure: Used as an emergency intervention during a sudden, painful spike in eye pressure to save vision.
Chronic Angle-Closure: For patients whose drainage system is permanently narrowed or partially blocked by the iris.
Preventative Care: If you have had an angle-closure attack in one eye, LPI is typically performed on the other eye as a preventative measure.
Anatomical Narrowing: When the iris is physically "bowed" forward, preventing the natural drainage of aqueous humor.
How Is Performed
Preparation: The eye is numbed with anesthetic drops. Specialized drops (like pilocarpine) are used to constrict the pupil, which thins the iris and makes it easier for the laser to penetrate.
Positioning: You sit at a slit-lamp machine—similar to a standard eye exam microscope—with your chin and forehead in a steady rest.
Focusing: A specialized contact lens is placed on the eye to focus the laser beam and keep your eyelids open during the pulses.
Laser Application: The surgeon uses a focused laser (commonly a YAG or Argon laser) to create a tiny opening in the outer edge of the iris, usually hidden under the upper eyelid.
Monitoring: You will remain at the clinic for 30 minutes to 2 hours post-procedure so the specialist can check for any immediate spikes in eye pressure.
Duration: The procedure is typically completed in 5 to 15 minutes per eye.
Pre-Procedure Preparation
Gonioscopy: A specialized diagnostic exam to view the drainage angle and confirm that the iris is causing the obstruction.
Medication Review: Discussing any blood thinners or history of eye inflammation (uveitis) with your surgeon.
Pupil Preparation: Being aware that the constricting drops used before surgery may cause a temporary brow ache or dim vision.
Transportation: Arranging for a ride home, as your vision may be temporarily blurred from the specialized lenses and laser light.
Tests Before Laser Iridotomy
Intraocular Pressure (IOP) Check: Establishing a baseline pressure to compare against post-laser readings.
Anterior Segment OCT: A high-resolution scan that provides a cross-sectional view of the drainage angle and iris position.
Visual Acuity: Measuring your current vision to ensure the laser treatment does not affect your baseline sight.
Slit-Lamp Examination: A microscopic check of the iris thickness and the health of the cornea before the laser application.
Life After Laser Iridotomy
Initial Recovery: Most patients return to normal activities within 24 to 48 hours.
Common Symptoms: Temporary blurred vision, mild headache, light sensitivity, or a "gritty" feeling in the eye are normal for a day or two.
Medication: You will be prescribed anti-inflammatory (steroid) eye drops to use for about a week to ensure the microscopic hole stays open and heals.
Activity Restrictions: Avoid strenuous exercise, heavy lifting, or rubbing the eyes for the first 2–3 days.
Follow-up: A pressure check and gonioscopy are usually performed 1 to 2 weeks later to confirm the angle has successfully opened.
Why Specialized Treatment Is Highly Effective
Prevents Blindness: It is the primary defense against acute angle-closure glaucoma, which can cause permanent blindness in hours if untreated.
Minimally Invasive: Requires no surgical incisions, no stitches, and is performed entirely in an office setting.
Permanent Solution: Once the microscopic hole is created and healed, it typically provides a life-long pathway for fluid flow.
Rapid Results: The internal pressure often begins to stabilize immediately after the bypass is created.
High Safety Profile: Complications are uncommon, and the procedure is considered the global standard of care for narrow-angle conditions.