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A laser iridotomy, also called a laser peripheral iridotomy, is a procedure that creates a small hole in the outer part of the iris. This provides an alternate pathway for aqueous fluid to move from behind the iris to the front of the eye. It is most commonly used to treat or prevent pupillary block in eyes with narrow angles on gonioscopy. The goal is to reduce the risk of angle-closure glaucoma and sudden pressure spikes.
read more about laser iridotomy ...Laser iridotomy is performed when pupillary block is suspected or when the angle is narrow enough to raise concern for closure. It is commonly recommended for acute primary angle closure, primary angle closure, and primary angle-closure glaucoma. It may also be used in secondary angle-closure situations when pupillary block is part of the mechanism. The decision is based on clinical exam, intraocular pressure readings, and angle assessment.
Before treatment, the eye is numbed and a drop that constricts the pupil may be used to thin the peripheral iris. A contact lens is placed on the eye to focus the laser. The doctor uses a laser, often neodymium-doped yttrium aluminum garnet (Nd:YAG) and sometimes argon, to create a small opening under the upper eyelid area to reduce visual symptoms. The opening is checked for patency and eye pressure is rechecked after the procedure.
It is common to have mild light sensitivity, redness, or blur for a short time. Anti-inflammatory drops are often prescribed, and intraocular pressure is monitored soon after the procedure because a temporary pressure rise can occur. Some people notice a brief line or light effect, especially if the opening is large or more exposed, but many do not notice it at all. Follow-up includes checking that the angle has opened and that the iridotomy remains patent.
Potential risks include transient increased eye pressure, inflammation, small bleeding from the iris, and corneal irritation from the contact lens. Less common risks include closure of the iridotomy, glare or halos, and rare damage to nearby structures. If you develop severe pain, nausea, vomiting, rapidly worsening redness, or sudden vision loss, seek urgent evaluation. Even after a successful iridotomy, some eyes need additional treatment if other mechanisms contribute to angle closure.
Usually no. The opening is typically placed in the peripheral iris under the upper eyelid, so it is not easily seen. Even when visible on close inspection, it looks like a tiny dark dot.
Most people feel minimal discomfort because numbing drops are used. You may feel brief pressure or a pinch-like sensation during laser shots. Significant pain is not expected and should be reported.
Laser iridotomy is mainly for narrow-angle or angle-closure mechanisms involving pupillary block. It is not a standard treatment for primary open-angle glaucoma, where laser trabeculoplasty or medications are more common. An eye exam is needed to determine the glaucoma mechanism.
It can greatly reduce risk when pupillary block is the primary cause of angle closure. However, some eyes have additional anatomical factors, such as plateau iris configuration, and may need further treatment or ongoing monitoring. Regular follow-up helps ensure the angle remains open and pressure stays controlled.
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Lens extraction versus laser peripheral iridotomy for acute primary angle closure: Evidence review. PubMed Central (National Library of Medicine, National Institutes of Health). https://pmc.ncbi.nlm.nih.gov/articles/PMC9994579/. Date Accessed February 5, 2026.
Quantification and Analysis of Laser Peripheral Iridotomies in the United States (2000–2021). PubMed Central (National Library of Medicine, National Institutes of Health). https://pmc.ncbi.nlm.nih.gov/articles/PMC12780361/. Date Accessed February 5, 2026.
Navigating decisional conflict: laser peripheral iridotomy for angle-closure disease. PubMed Central (National Library of Medicine, National Institutes of Health). https://pmc.ncbi.nlm.nih.gov/articles/PMC11947537/. Date Accessed February 5, 2026.