Iridotomy

A good vision depends on a healthy eye canal system through which a fluid known as 'aqueous humour' flows and drains out. But sometimes, resistance arises within this channel which disrupts the flow of aqueous humour and blocks it. This can result in blurred vision or loss of sight. Such a condition can be treated through Iridotomy. 

Iridotomy is an eye procedure that treats the condition caused due to the building of intraocular pressure inside the eyes. This happens due to the inability of aqueous humour to drain out of the eyes.

 

To prevent sudden rise in eye pressure (Acute glaucoma)

The flow and drainage of aqueous humour are essential for the normal working of vision. But sometimes, the Iris moves forward, blocking the channels of drainage. This condition is known as closed-angle Glaucoma (मोतियाबिंद), where the space between the Cornea and Iris gets closed in many areas. Due to this condition, the Schlemm canal cannot deliver aqueous humour to the blood vessels, and results in pressure building up. As a result, the patient experiences the following symptoms:

1. Dim or blurred vision
2. Loss of eyesight
3. Loss of peripheral eyesight
4. Pain in eyes
5. Seeing rings of light around lighted objects or lights
6. Nausea
7. Different-sized pupils
8. Iridotomy improves the outflow of aqueous humour and lowers the intraocular pressure.

 

If the procedure is delayed, the intraocular pressure builds up inside the eye due to blocked drainage, which can be dangerous. It may:

1. Cause damage to the optic nerve 
2. Result in gradual loss of vision
3. The patient might develop Glaucoma

Sometimes, the pressure builds up rapidly inside the eye which is an emergency condition. Any delay in such cases can lead to permanent blindness.  

However, the treatment is not an emergency for everyone. If a patient has less than a half-closed angle between Cornea and Iris and the pressure is also less, they are in a low-risk zone. In this case, Iridotomy acts as a preventive treatment.

 

Depending on the severity of intraocular pressure building up in your eye, a surgeon will equip you with a suitable treatment plan. The surgeon may first prescribe some eye drops and oral medications to decrease the amount of fluid made in your eyes. These drugs will bring the pressure down to the desired level, followed by laser and surgical procedures described as under:

Laser Peripheral Iridotomy Procedure

1. Laser Iridotomy procedure is done to rectify the drainage channels that have been narrowed or blocked by the Iris in a condition known as angle-closure Glaucoma. 
2. Some amount of eyesight may already be lost due to angle-closure Glaucoma. In that case, this treatment helps save the sight a patient still has. 
3. The surgical treatment involves the use of laser technology.
4. The surgeon uses a laser beam and creates a small hole in the Iris of the patient’s eye.
5. The hole creates a passage for the aqueous humour to flow through, lowering the pressure in the eye.
6. Due to the surgery, the Iris tissue pushes backward and unblocks the drainage channels. 

Trabeculectomy

1. If laser Iridotomy does not work, the patient may be treated with Trabeculectomy.
2. Trabeculectomy is a surgical procedure used to decrease the intraocular pressure in the eye by building a filtration system for aqueous humour.
3. The surgery begins by administering several eye drops to sterilise the eyes.
4. The surgeon gives a topical anaesthesia  to the patient.
5. A piece of eye tissue from the eye's drainage angle is removed.
6. This creates an opening for the aqueous humour.
7. The surgeon cuts open the eye's sclera for aqueous humour to drain.
8. A filtration reservoir is created in the white part of the eye, which appears as a bump. This is known as 'bleb'.
9. The aqueous humour gets collected in the bleb and is absorbed by the surrounding blood vessels, decreasing the intraocular pressure.
10. The scleral flap is then closed.

Drainage Tubes Procedure

1. In this procedure, a silicone tube is connected to a drainage plate. 
2. The surgeon inserts the silicone tube into the eye and stitches the drainage plate into the sclera.
3. The fluid gets collected in the drainage plate.
4. After getting collected in the plate, the fluid is absorbed by the surrounding eye area's tissues.
5. This helps in lowering the intraocular pressure. 

Minimally Invasive Glaucoma Surgery (MIGS)

1. Your doctor may prescribe MIGS which is safer than other surgeries like Trabeculectomy and drainage tube procedures.
2. MIGS requires less care after the operation and helps in lowering the intraocular pressure with fewer complications. 
3. Doctors can combine MIGS techniques with other eye complications. They will prescribe them as per the condition of the patient.

1. A consultation session will take place where the doctor will understand your eye condition and symptoms. 
2. After the consultation, there will be a detailed eye examination which might include some tests to check if there is any vision loss or damage to the optic nerve.
3. Your doctor will also measure the intraocular pressure and examine the drainage angle of your eye.
4. After checking these details, the doctor will prescribe a suitable treatment for your eye condition.
5. The patient signs a consent form stating that he/she understands the treatment and agrees with it.

1. On the day of the surgery, the patient need not do fasting or special preparations.
2. The doctor will conduct an eye examination and assess the intraocular pressure.
3. The nurse or surgeon will administer eye drops to lower the amount of fluid made by the eyes at least half an hour before the surgery. This will also narrow the pupil and drop the pressure. In some cases, the doctor may also give oral medication to the patient to bring down the pressure. 
4. The doctor will give anaesthetic eye drops to numb the patient's eyes.
5. The patient will be made to sit in a relaxed position, and treatment is performed with the help of a laser beam or other required apparatus.
6. The patient may feel slight discomfort during the laser surgery for about 15-20 minutes.

1. The patient is made to sit in the waiting area after the surgery.
2. After some time, the doctor will check the eye pressure and examine if the new opening is working well.
3. The doctor will prescribe medications and eye drops to be taken by the patient for some time so that he/she gets the best result from the treatment.
4. The patient will be prescribed some safe exercises to reduce the pressure in the eye.
5. The doctor usually prescribes some pain relievers if the patient feels discomfort after the treatment.
6. The patients may expect sticky eyelids for some time. This will subside after some time of administering eye drops.
7. The vision may be blurred for some time. This will return to the earlier state within a few hours.

First Follow up Treatment

1. The patient is asked to follow up after a week or two to ensure that his/her eyes are responding well to the treatment performed.
2. After the surgery, the patient should switch to a healthy diet rich in Vitamin A, C, & E.
3. The patient should avoid beverages with a high amount of caffeine.

You should see a doctor if:

1. Eye pressure rises after the treatment.
2. The opening due to the procedure is not big enough to drain the aqueous humour. The doctor can find this during a follow-up visit.
3. Any eye inflammation that does not subside has to be brought to the doctor's notice.
4. You experience excessive pain in the eyes. 
5. One or both of your eyes are increasingly becoming red.
6. You see flashing lights/halos around light.