Laser Iridotomy

What is Laser Iridotomy?
There are many different types of glaucoma and the treatments are varied. Laser iridotomy is a treatment that is used for patients who have, or who are at risk of, developing acute angle closure glaucoma, or who have chronic closed or narrow angle glaucoma. In acute angle closure glaucoma the watery fluid called aqueous humour is unable to pass into the front chamber of the eye and then drain satisfactorily. The iris (coloured part of your eye) may be pushed forward on to the delicate drainage system and restrict the flow of aqueous so that the pressure within the eye goes up.

Laser iridotomy is the preferred treatment in these cases and is used to prevent the pressure rising in eyes at risk with narrow angles. The laser delivers a highly concentrated beam of energy, which is used to make a small hole in the iris. This small hole allows the aqueous humour to flow freely in to the front chamber of the eye.

What happens on the day of treatment?
The nurse or I will check your vision and put some drops in to your eye to make your pupil smaller. These drops are used to prevent the pressure rising within your eye. The drops take up to one hour to work. I will take your written consent and explain further if you have any questions. You will also have anaesthetic drops put in to your eye to numb the front surface.

Once seated in front of the laser machine, which is similar to the microscope you will have been examined on in clinic, a special lens will be placed against the front surface of your eye. This is not painful, although it may feel a little strange. During the laser treatment, you will hear clicking noises. The laser treatment is generally painless, although some patients feel a slight pain lasting a second or less.

After the laser treatment, you will have further drops put in your eyes to help reduce any inflammation caused by the laser. The pressure in your eye will be checked about an hour after the treatment, before you go home.
You will then receive a prescription for drops to take at home and we will arrange an appointment to come back to the clinic usually about 1 week later.

Are there any risks or side effects of this treatment?
Your vision may be slightly blurred for a few hours following your laser treatment. This will settle. If you are concerned that your vision is not returning to normal please contact the hospital on the numbers below. It is advisable that you do not drive yourself to the hospital, as you will be unable to drive home.

There may be a little bleeding inside your eye, which will initially blur your vision however this will clear in a few days time. Your eye may feel slightly bruised afterwards and sometimes become inflamed but the drops you have been given to use will control any inflammation and help to relieve discomfort.

You may wish to take a mild painkiller, for example Paracetamol, to relieve this discomfort. If you are already taking painkillers for a different condition continue with these, but do not take both.

It is possible for the pressure in your eye to increase immediately after the treatment. In order to prevent this we put in some special drops before and immediately after the treatment.

The small hole in your iris is usually hidden under the upper eyelid and cannot be seen with the naked eye. However, very occasionally, it can cause glare or other problems.

How successful is laser iridotomy?
Laser iridotomy is very successful. However, occasionally the small hole can partly or completely heal up in the first few days after the laser treatment. Further laser treatment may be necessary following your review in clinic. This is usually very successful. Laser iridotomy is very good at protecting against acute angle closure glaucoma.

The information here is intended as a guide only, as each patients experience will be different.

Consultants who undertake private cataract surgery:

Leon Au