Laser Peripheral Iridotomy (LPI)

What is laser peripheral iridotomy?

LPILPI, or laser peripheral iridotomy, is a treatment used to prevent or treat narrow angle glaucoma. It uses a focused laser beam to make a microscopic hole in the colored part of the eye, the iris. The small hole can improve the shape of the front part of the eye, and allow for fluid to flow more normally and enable the drainage system of the eye to become unblocked.

What does the LPI procedure entail?

Most of our lasers are performed at a local surgical center in one of the laser treatment rooms. However, unlike typical incisional surgery, you will not need to make any special preparations such as fasting or changing clothes.

The nurse will check you first, have you sign some forms, and apply a number of topical medications including a miotic drop (to make your pupil smaller), an eye pressure lowering drop, and an anesthetic drop to numb the eye.

The laser iridotomy is performed on a machine similar to the one used to examine your eye in the office, except there is a laser attached to his one. The eye doctor will then place a special contact lens on your eye to help keep the eye open and better aim the laser.

The treatment itself lasts only a few minutes. Many people describe a “snap” or “pinch” of brief pain. Some people experience a mild to moderate aching discomfort which may be due to the laser or some of the eye drops used to prepare for the laser. Most discomfort rapidly improves or can be managed with Tylenol or an NSAIDs such as ibuprofen.

After the procedure, you will return to the waiting area briefly and then you are free to return home. There are no restrictions after your laser treatment. Your vision may be blurred for the remainder of the day, and you may have some mild light sensitivity or achy pain. You will receive a prescription for a topical steroid drop to help with the healing and your recovery. We recommend that you start the treatment as soon as you get home.

We asked that you return to the office to have your eye pressure checked either the same day or the following day.

What are the benefits of having a laser iridotomy?

The laser treatment is used to prevent you from having a sudden attack of glaucoma which can lead to irreversible blindness. It is important to remember that this procedure will not restore or improve your sight.

What are the risks of having a laser iridotomy?

Complications with laser iridotomy are very rare. However, you may experience one of the following side effects:

  • The laser may cause inflammation (irritation) in the eye, bleeding, or a rise in eye pressure. These issues are usually mild and short-lasting, and typically improve with topical medications used for a short period of time.
  • Sometimes the hole that is made in the iris is either incomplete, too small, or it may scar closed. If this is the case, you will require a return to the surgical center for additional treatment.
  • In about 10-15% of patients, the laser hole is open, but the shape of the front part of the eye or the eye pressure does not improve. If this occurs there are other medical or surgical treatments that may be necessary.
  • A small number of patients may note some increased light, glare, or ghost images through the new opening in the iris. Most of these symptoms improve with time.

What are the alternatives to having a laser iridotomy?

Some patients may elect to be observed without undergoing the laser, as “narrow angle glaucoma suspects.”  Patients who decline laser may need to avoid certain medications – like Tylenol PM, Benadryl, anti-depressants, or motion sickness medications to avoid precipitating an angle closure glaucoma attack. Patients who decline laser treatment need to seek immediate ophthalmic attention if they develop headaches or nausea and vomiting associated with eye pain or blurry vision (symptoms of an angle closure glaucoma attack). Cataract surgery may be an appropriate alternative to a laser iridotomy.

Your doctor will discuss your narrow angle glaucoma risk and cataract status to determine the proper course of action.

Consent

All procedures on your eyes require your consent. The above material will be reviewed, and we will address any questions or concerns you may have.

What to Do Once You Get Home

As mentioned above, you will start topical steroid drops for usually one week. If you are on glaucoma medications, you should continue to use them unless the doctor has told you otherwise. Avoid any medications that warn “Do not take if you have glaucoma or narrow angle glaucoma” until otherwise directed by your doctor. You can return to all your activities of daily living without any restrictions.

To schedule your appointment with one of our glaucoma specialists, and learn if LPI treatment is right for you, please contact Eye Doctors of Washington.

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