Laser Peripheral Iridotomy (LPI)
Laser Peripheral Iridotomy (LPI)
Author: Aanya Roy and Aashna Bhakkad
Purpose: A laser procedure that creates a small hole in the peripheral iris (the colored part of the eye) to improve the flow of aqueous fluid between the anterior and posterior chambers. It is primarily used to prevent or treat angle-closure glaucoma by relieving pressure buildup behind the iris.
When LPI is needed:
- Narrow or occludable angles detected during eye exam
- History or signs of acute angle-closure glaucoma
- High risk for angle closure based on family history or eye anatomy
- As a preventative treatment in the fellow eye of a patient with one affected eye
- When intraocular pressure (IOP) spikes due to blocked fluid flow
Procedure:
Setting: Outpatient procedure in an ophthalmologist’s office
Time: Usually 5–10 minutes per eye
Laser Used: YAG laser or argon laser, sometimes in combination
Function: Creates a new channel for fluid to flow through the iris, bypassing the pupil to reduce or prevent pressure buildup
Steps
- Numbing drops are applied to the eye
- Pupil may be constricted using a miotic agent (e.g., pilocarpine) to stretch the iris and reduce risk of bleeding
- Patient places head on the laser machine’s headrest
- A special contact lens with gel is placed on the eye to stabilize and focus the laser
- The laser is aimed at the peripheral iris (usually superior—under the upper eyelid for better cosmetic results)
- Laser pulses create a tiny full-thickness hole in the iris (0.2–0.5 mm)
- The contact lens is removed and the eye is rinsed
- Intraocular pressure is checked shortly after
- Anti-inflammatory eye drops (e.g., steroids or NSAIDs) are prescribed for a few days
What to Expect After LPI
Temporary blurry vision, mild discomfort, redness, or light sensitivity
Eye pressure may fluctuate—follow-up checks are important
Most return to normal activities same day but should rest
Avoid rubbing the eye and water exposure for 24–48 hours
Benefits
Prevents or stops acute angle-closure attacks
Reduces risk of vision loss from high eye pressure
Quick, outpatient procedure with minimal recovery
May avoid the need for emergency glaucoma surgery
Provides long-term protection for angle-closure risk
Risks (Mostly Mild & Temporary)
Inflammation (treatable with drops)
Blurry vision, glare, or light sensitivity
Temporary IOP spike
Rare: bleeding, corneal edema, lens damage, or need for retreatment
Citations:
Gustianty, Elsa. “Evaluating the Effectiveness of Laser Peripheral Iridotomy on Angle-Closure Diseases: The Role of Spectral Domain Anterior Segment Optical Coherence Tomography (SD AS-OCT) in Indonesia Tertiary Eye Hospital.” The Open Ophthalmology Journal, vol. 19, no. 1, 26 Feb. 2025, openophthalmologyjournal.com/VOLUME/19/ELOCATOR/e18743641337429/FULLTEXT/.
IM Miguel, Ana, and André Borges Silva. “Laser Peripheral Iridotomy – EyeWiki.” Eyewiki.org, 22 Dec. 2023, eyewiki.org/Laser_Peripheral_Iridotomy? Accessed 1 Aug. 2025.
Joy, Rebecca. “Will Medicare Cover Glaucoma Care?” Healthline, Healthline Media, 14 Sept. 2020, www.healthline.com/health/medicare/does-medicare-cover-glaucoma?
Kelly, Sonia . “Laser Peripheral Iridotomy (LPI) | Narrow-Angle Glaucoma Treatment.” Allaboutvision.com, 14 Apr. 2025, www.allaboutvision.com/treatments-and-surgery/vision-surgery/glaucoma/laser-peripheral-iridotomy/?
Paretts, Susan. “Glaucoma Treatments, Costs and Insurance Explained.” Carecredit.com, 13 Dec. 2021, www.carecredit.com/well-u/health-wellness/glaucoma-surgery-cost-financing/.
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