Introduction

Laser peripheral iridotomy is a medical procedure which uses a laser device to create a hole in the iris, thereby allowing aqueous humor to traverse directly from the posterior to the anterior chamber and, consequently, relieve a pupillary block. It is commonly used to treat a wide range of clinical conditions, encompassing primary angle‐closure glaucoma, primary angle closure (narrow angles and no signs of glaucomatous optic neuropathy), patients who are primary angle‐closure suspects and even eyes with secondary causes of iridocorneal angle-closure.

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 (anterior chamber) that is caused by sudden (acute) or slowly progressive (chronic) blockage of the normal circulation of fluid within the eye. The block occurs at the angle of the anterior chamber that is formed by the junction of the cornea with the iris.

All one needs to do to see this angle is to look at a person's eye from the side. Angle closure of the eye occurs when the trabecular meshwork, the drainage site for ocular fluid, is blocked by the iris. Laser iridotomy was first used to treat angle closures in 1956. During this procedure, a hole is made in the iris of the eye, changing its configuration. When this occurs, the iris moves away from the trabecular meshwork, and proper drainage of the intraocular fluid is enabled.

Demography

Acute angle glaucoma occurs in one in 1,000 individuals. Angle-closure glaucoma generally expresses itself in populations born with a narrow angle. Individuals of Asian and Eskimo ancestry appear to be at greater risk of developing it. Family history, as well as age, are risk factors. Older women are more often affected than are others. Laser iridotomy is performed on the same groups of individuals as those likely to experience angle closures due to pupillary block or plateau iris.

They are performed more often on females (whose eyes are smaller than those of males), and more often performed on the smaller eyes of farsighted people than on those of the nearsighted because angle closures occur more frequently in those who are farsighted. Most laser iridotomies are performed on those over age 40 with a family history of plateau iris or narrow angles.

Surgery

Many people are concerned about possible pain and side effects of laser iridotomy. Generally speaking, the procedure is nearly painless. Your eye is anesthetized with numbing eye drops, and a small lens is placed on the surface of the eye to help focus the laser.

During the actual laser procedure itself, you may feel a sensation that something happened or a pinprick sensation, or you may feel nothing at all. The laser usually makes a noise when fired, which can be somewhat startling.

The procedure is fairly short, so if pain is a potential side effect, it is short-lived. After the laser iridotomy is completed, the eye may be a little red, light sensitive, and uncomfortable for the first 24-72 hours after the procedure.

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