Glaucoma

Narrow Angles & Laser Peripheral Iridotomy

Everybody is uniquely different, and some of us may have eyes with narrow angles. A person who has eyes with narrow angles can have obstructed drainage of fluid from the eyes and are at risk of developing angle-closure glaucoma. 

 

Glaucoma is the damage to the optic nerve inside the eye related to high eye pressure or obstructed drainage of fluid from the eye.  Used since 1984, Laser Peripheral Iridotomy is the go-to treatment for narrow angled eyes or Primary Angle Closure Glaucoma.

What are narrow angles?

The eye is continually producing and draining fluid. This fluid circulates through the eye and drains out via an angle passage located where the iris (coloured part of the eye) meets the cornea (clear window at the front of the eye).

Some eyes have acute angles, which is referred to ‘narrow angles’. Narrow angles can seal the drainage area of the eye, preventing fluid from draining easily.

The dangers of narrow angles

Whilst narrow angles haven’t completely locked the drainage system in the eye, it can quickly lead to the development of “angle closure”, a condition where the drainage system is completely closed off. Fluid produced by the eye accumulates, and becomes entrapped leading to raised pressure in the eye, causing glaucoma.

Rarely, narrow drainage angles can completely block off, causing a sudden and dramatic attack of angle closure. This is a rapid, large rise in eye pressure causing eye pain, headache and blurred vision. It can lead to permanent visual loss if not treated immediately.

Open Angle

14. normal circulation of fluid

 

Narrow Angle

14. Narrow drainage angles

 

How does the Laser Peripheral Iridotomy work?

During the LPI, a laser is used to make a small hole in the peripheral iris (coloured part of the eye).  This small opening essentially opens the narrow angle and allows fluid to pass freely within the circulatory system of the eye; that is fluid passing from behind the iris to in front of the iris. The widening of this angle in the peripheral iris allows fluid to drain as normal, lowering eye pressure and the risks of glaucoma or the glaucoma condition progressing further.

Laser iridotomy (arrow)

narrow 4

 

Prior to Laser Peripheral Iridotomy

In most cases you will be given a script for Maxidex (dexamethasone) 4 times daily and Alphagan P (brimonidine) 2 times daily eye drops. Please collect the drops before your laser treatment and bring them unopened to your first laser treatment. You will use these drops as instructed for one week after the procedure. Unless otherwise instructed please continue any current medication as per usual.

During Laser Peripheral Iridotomy

Shortly after you arrive numbing eye drops will be given to ensure the treatment is comfortable. you may feel a brief sensation of discomfort, like a “zap” that passes instantaneously. The laser procedure itself will take approximately 1-2 minutes.

Laser Peripheral Iridotomy Recovery

There are no restrictions on your activities after laser treatment. You are also safe to drive after treatment. You may feel mild eye discomfort, headache or blurred vision that resolves within hours/days.

How many appointments do I need for Laser Peripheral Iridotomy?

You will need 3 appointments: one for each eye that receives the laser on a separate day, and then one for a final review. These are usually booked 1-2 weeks apart.

Laser Iridotomy

15. laser iridotomy

Iridotomy

16. iridotomy

Accreditations & Credentials

Dr Skalicky is an active clinician, surgeon, researcher, teacher, academic and health advocate who has published over 40 articles in international Ophthalmology journals. Known as an Ophthalmologist ahead of the times, Dr Skalicky’s career highlights are exceptional and atypical for his age.