Laser Peripheral Iridotomy (LPI)
LPI is a laser treatment used to treat narrow angles. A microscopic hole is created in the colored part of the eye (iris). This hole can change the configuration of the drainage system within the eye, so that aqueous fluid is able to flow more normally and help prevent an acute attack of angle closure glaucoma. Drops to constrict the pupil and an eye pressure lower drop is applied to the eye. The pupil constricting drop may give some people an “ache” over the brow, but this is temporary. The eye is then numbed and a special contact lens is placed in your eye. Usually the laser treatment only lasts a few minutes. Some people may experience a brief pinch of discomfort with the laser. After the laser is completed, your eye pressure is checked and you can go home without any restrictions. If you are taking glaucoma medications, you should continue them. A topical steroid drop is prescribed for a few days to help with the healing process. Risks of laser iridotomy include inflammation (which is expected and treated with steroid drops), increased eye pressure, bleeding, glare or line of light in their vision. The glare or line of light is extremely uncommon and most people notice that this symptom improves with time. Sometimes, if the hole that is created is is too small or incomplete, it may close and a second treatment may be required. Occasionally, the drainage system may still remain narrow after the laser iridotomy and other medical or surgical treatments may be necessary depending on the individual.
If you have narrow angles and decline treatment, certain medications should be avoided as they can precipitate an acute attack of angle closure glaucoma. These medications usually have a warning on the label instructing you to not take them if you have glaucoma. Some examples of medications to avoid include: allergy/cold remedies, some asthma medications (atrovent or spiriva), some anti-depressant medications (prozac, paxil, amitryptiline) or motion sickness medications. The symptoms of an acute attack of angle closure glaucoma includes: sudden red painful eye, blurry vision, headaches, colored halos and nausea and vomiting. If you develop these symptoms, you need to seek immediate ophthalmic attention.
Cataract surgery may be an appropriate alternative to laser iridotomy in some people.