Laser Iridotomy

What is YAG laser iridotomy and when is it indicated?

YAG laser iridotomy creates a small, permanent opening at the periphery of the iris, so that aqueous humour can drain normally. It is indicated when there is narrowing or closure of the angle and a risk of angle-closure glaucoma or an acute glaucoma attack.

It is performed at the practice, without an incision, under local anaesthesia, and is part of the care for glaucoma and related tests such as visual fields and OCT RNFL. The goal is to protect the optic nerve when gonioscopy and the clinical picture require it.

The procedure aims at:

• Preventing an acute glaucoma attack in a "suspicious" or high-risk narrow angle
• Immediate treatment during or after an acute attack, according to the treatment plan
• Treating a narrow or closed drainage angle, to reduce the likelihood of a sudden rise in intraocular pressure

Why might I need laser iridotomy?

Many people with a narrow angle remain asymptomatic, yet the angle can close suddenly or gradually, with a rise in pressure and a risk to vision. Iridotomy is proposed after a full examination, when preventive or therapeutic intervention is needed.

Particular attention is paid to hyperopia, a short eye, a family history of glaucoma, or a previously "suspicious" angle. The decision is based on the angle, the nerve, the fields and, where needed, imaging tests — that is, on the overall management of glaucoma.

Being informed about emergency symptoms and adhering to follow-up appointments strengthens the safety of the treatment strategy.

Systematic review after the decision for iridotomy helps confirm that the angle and pressure remain within acceptable limits afterwards.

What is the risk if treatment is not performed when indicated?

The risk is individualised (initial assessment and monitoring).

With normal pressure but a narrow angle, the risk of acute glaucoma or closure is small but real; preventive iridotomy is judged on a case-by-case basis.

With higher risk or raised pressure, delay can lead to chronic/acute glaucoma and permanent nerve damage.

Sudden angle "closure" can cause a sharp rise in pressure, with:

• Severe eye pain
• Redness ("red eye")
• Nausea or a feeling of being unwell
• Blurred vision or reduced vision, occasionally permanent if not treated promptly

This situation (acute glaucoma) is an ophthalmological emergency and requires immediate treatment; teaching patients to recognise the symptoms is part of responsible care.

How does laser iridotomy work?

Normally, aqueous humour is produced by the ciliary body and drains through the angle. When the angle is narrow, the iris can block the normal outflow of fluid, leading to a rise in intraocular pressure.

With the YAG laser, a small opening is created at the periphery of the iris. Through this opening:

• Normal flow of aqueous humour toward the drainage angle is restored
• The obstruction at the narrow or closed angle is bypassed
• The risk of a sudden pressure rise linked to angle closure is reduced

At the same time, forward movement of the iris, which could worsen the narrowing, is limited. Iridotomy does not always remove the need for drops or other glaucoma treatments in every case; it is often combined with SLT laser or medication, depending on the type and severity of the glaucoma.

After the procedure, follow-up is individualised: additional tests or combination with SLT and treatment may be needed as part of managing glaucoma. Regular checks of the angle and pressure, together with nerve assessment where indicated (e.g. visual fields / OCT RNFL), ensure the plan remains suited to your clinical course.

The procedure at the practice and postoperative follow-up

With anaesthetic eye drops, the application takes only a few minutes per eye, followed by a pressure check according to protocol.

Possible temporary blurring, mild discomfort, light sensitivity or a small surface haemorrhage usually resolve.

Sometimes re-examination or supplementary treatment is needed.

YAG laser, cataract and other applications in ophthalmology

The same YAG laser is also used elsewhere (e.g. posterior capsulotomy after cataract surgery when the capsule becomes cloudy); details at YAG laser capsulotomy.

Having multiple applications does not mean everyone needs them — the decision is individual, weighing safety and benefit for vision. For an angle check or questions: services, contact.