Laser peripheral iridotomy (LPI)

Laser peripheral iridotomy (LPI) is the preferred procedure for treating closed-angle glaucoma.

What is closed angle glaucoma?

The angle is the space between the clear part of the eye (cornea) and the colored part (iris), close to their meeting point near the edge of the iris. In closed angle glaucoma, the angle is closed in many or most areas, causing increased eye pressure, which leads to optic nerve damage, and possible vision loss. This rise in eye pressure may occur suddenly (an acute attack of angle closure) or gradually.

How does laser iridotomy work?

It creates a hole in the outer edge of the iris, leading to an opening of the angle in the majority of cases. After the angle is widened from the procedure, fluid outflow is enhanced.

Who is a candidate for laser iridotomy?

It is recommended in eyes which have the angle closed for at least half the eye. This is determined with a test called gonioscopy, which is done by the eye doctor in the office.

What should I expect during the procedure?

The eye is usually pretreated about half an hour before the procedure with drops that make the pupil small. Just before the procedure, anesthetic drops are placed to numb the surface of the eye, a lens is then placed on the eye to perform the laser. The procedure usually takes 5-10 minutes and some patients may experience minor pain.

What should I expect after the procedure?

There is temporary blurriness of vision. The eye may be a little red, light sensitive, and/or uncomfortable, and there may also be a mild headache due to the eye drops given before the laser. The eye pressure is usually assessed within 30 minutes to 2 hours after the laser and anti-inflammatory eye drops are usually prescribed for a few days.

Will the laser improve my vision?

No. Iridotomy is intended to preserve the vision and prevent glaucoma from appearing or progressing.

What happens if it doesn’t work?

In about 25% of cases, the angle may not open. Depending on the situation, some patients might need further laser procedures, medical treatment, or surgery. It may be possible that your ophthalmologist suggests close follow up.

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