YAG Iridotomy

Our glaucoma specialists recommend YAG iridotomy when the anatomy of your eye places you at elevated risk for a sudden and potentially sight-threatening spike in eye pressure. The procedure addresses the underlying cause of narrow-angle glaucoma rather than simply managing symptoms.

An acute angle-closure attack happens when the drainage angle of the eye closes completely, trapping fluid inside and causing eye pressure to rise rapidly. This can lead to severe eye pain, nausea, blurred vision, and halos around lights. Without prompt treatment, the optic nerve can sustain permanent damage within hours. By creating an alternate drainage pathway before an attack occurs, a YAG iridotomy significantly reduces the risk of this ophthalmic emergency.

Not all patients with narrow angles will experience an acute attack, but the risk remains present over time. During a comprehensive glaucoma evaluation, our specialists use gonioscopy, a technique that examines the drainage angle with a special lens, to determine how narrow your angles are. If the angle is narrow enough to pose a meaningful risk, a prophylactic YAG iridotomy is often the safest approach. This is especially important because narrow angles can gradually worsen with age as the natural lens of the eye continues to grow.

The most common cause of angle closure is a condition called pupillary block, where the iris presses against the lens of the eye and restricts the normal forward flow of aqueous humor. As fluid accumulates behind the iris, it pushes the iris forward and narrows or closes the drainage angle. A YAG iridotomy eliminates pupillary block by providing a direct channel through the iris, equalizing pressure on both sides and allowing the iris to fall back into its normal position. In cases where the angle remains narrow despite a patent iridotomy, our team may explore whether additional glaucoma surgery is needed.

Most patients experience little to no pain during the procedure. The anesthetic drops applied beforehand numb the eye surface, and the laser pulses feel like a small tap or mild flicker of light. Some patients report a brief sensation of pressure when the contact lens is placed on the eye, but this is generally well tolerated. Any mild discomfort typically resolves within a few hours after the procedure is complete.

The laser treatment itself usually takes between two and five minutes per eye. However, you should plan to spend about one to two hours at our office to allow time for the pre-treatment drops to take effect and for post-treatment pressure monitoring. The overall time commitment is minimal compared to the long-term protection the procedure provides against angle-closure events.

Recovery is typically quick and straightforward. Most patients return to their normal daily activities within one to two days. You will use anti-inflammatory eye drops for approximately one week after the procedure. It is normal to experience mild light sensitivity or slight blurriness for the first day or two. A follow-up appointment is usually scheduled within one to four weeks to confirm the iridotomy is open and your eye pressure is stable. For a broader look at what recovery looks like after different glaucoma procedures, you may find our guide to glaucoma surgery recovery timelines helpful.

YAG iridotomy is considered a very safe procedure, but as with any medical intervention, there are some risks to be aware of. The most common is a temporary spike in eye pressure immediately after the procedure, which is why we monitor you in the office afterward. Other uncommon risks include mild bleeding at the iridotomy site, which usually resolves on its own, inflammation, and rarely, visual symptoms such as a line of light or a glare effect caused by light entering through the iridotomy opening. Serious complications, such as damage to the lens or sustained elevated eye pressure, are rare.

In some cases, the iridotomy opening can close over time as the iris tissue heals. If this happens, the procedure can be safely repeated to create a new opening. Our glaucoma specialists check the iridotomy at follow-up visits to confirm it remains patent. If a second treatment is needed, it follows the same straightforward process as the original procedure. In rare situations where other approaches may be required, our team can discuss options such as cyclophotocoagulation or other surgical strategies depending on your overall glaucoma management plan.

YAG iridotomy is highly effective at eliminating pupillary block, which is the most common mechanism behind angle-closure glaucoma. Prophylactic iridotomy reduces the risk of an acute angle-closure attack to near zero in the vast majority of treated patients. However, it is important to understand that not all forms of angle closure are caused by pupillary block alone. Some patients have plateau iris syndrome or other anatomical factors that can contribute to angle narrowing even after a successful iridotomy. For this reason, continued monitoring with our glaucoma specialists remains an essential part of long-term care.