How it works
In an eye with narrow angles, fluid passing from behind the iris through the pupil can meet resistance, and the pressure difference pushes the iris forward against the drainage angle. An iridotomy (an opening about the width of a hair near the edge of the iris) equalizes the pressure on both sides of the iris so it flattens back and the angle opens. Once made, the opening is permanent in most eyes.
The procedure
A drop constricts the pupil and thins the iris, and a numbing drop is placed. A contact lens is held on the eye to focus the laser. A series of laser pulses, usually a YAG laser sometimes preceded by an argon laser, creates the opening, typically under the upper eyelid where it is hidden. You may feel a small pinch with each pulse and see a flash. The whole visit, including a pressure check afterward, typically takes under an hour.
Afterward
Vision is blurred and the eye may ache for a few hours. Anti-inflammatory drops are used for about a week. A small proportion of patients notice a line or glare from light entering the new opening, which usually fades; placing the iridotomy under the lid minimizes it. Pressure is checked within an hour and again in the following weeks, and gonioscopy confirms the angle has opened.
Iridotomy or lens extraction?
Removing the natural lens deepens the angle more completely and permanently than an iridotomy, and a large trial showed it to be more effective in established angle-closure glaucoma. For patients with a cataract, or with angle closure that has already raised pressure, cataract surgery is often the recommended treatment. For narrow angles without damage, particularly in younger patients with a clear lens, iridotomy remains the simpler first step. Your evaluation sets out which applies.
Is this right for your eyes?
Nothing on this page is a diagnosis. Whether this is the right choice for you is decided by a full examination at one of our 4 offices: Pasadena, Huntington Beach, Woodland Hills and Beverly Hills.
About this content: This page was written with the assistance of AI tools and reviewed for medical accuracy by Dr. Bavand Youssefzadeh, DO. It is general information, not medical advice, and does not replace an eye examination. Individual results vary. Read our medical disclaimer.
