What Can I Do About the Side Effects of an Iridotomy?

April 27, 2010

I had laser surgery 10 months ago. An iridotomy was done to my eyes, because I have narrow angles. During and after the procedure I was in great pain, but the pain stopped 3 days later. Ever since the surgery I see a broad fluorescent white line in the middle of my vision, which drives me crazy. Besides, I have double vision and am extremely sensitive to light. My IOP was 15/16 before surgery and is now around 30. I now need glaucoma drops, which I didn’t need before. My visual acuity dropped from 20/20 in both eyes to 20/80 in my left eye and 20/100 in my right eye.

Is there any chance that the white line, the double vision, and the glare will eventually go away, that my visual acuity will improve and that my IOP will come down? My doctor says sometimes iridotomies have these side effects and I have to put up with it. Why didn’t he tell me before he performed the iridotomies? I am absolutely desperate. I lost my job because of my poor vision after the surgery. Can anyone help me?




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91 Responses to “What Can I Do About the Side Effects of an Iridotomy?”

  • Mary

    I had a closed angle attack in July of 2011. My highest IOP was 60! We got the pressure down by using drops. A week later I had the iridotomy on the affected (left) eye. An iridotomy was done on the right eye a week later. I can see a light come in through the opening in my left (affected eye). It looks like a prism with rainbow colors. But, the problem is I have double vision. I have a terrible time reading. My vision is blurred as well.

    My right eye has “lazy eye” which didn’t get surgically corrected (cosmetic) until I was 12. My right eye is my weak eye. The muscle may have stretched out and now my right eye wanders more again. I am wearing glasses with prisms, but I am doubtful that it is helping. The double vision goes away when I close one eye. It seems that I only notice the double vision in my left eye, but it is my dominant eye, so it’s hard to tell. My visual acuity decreased after the iridotomies. I don’t care if the experts are saying it is rare for the iridotomy to cause problems with blurred vision and diplopia. The problems need to be addressed. How do we improve my vision?

  • ari

    if you have narrow angles, you’d be crazy not to get the laser. its not surgery. its a quick procedure, and rarely gives patients problems. the benefits far outweigh the risk. driving a car is much riskier than the laser, yet you dont think twice about doing it every day. i feel you are making a grave error. get a second opinion about whether your angles are narrow and at risk for closure, and if confirmed, get it done. angle closure glaucoma is a disaster, and you dont want it- trust me.

  • Mrs. Cleveland

    I was told that I have narrow angles and was sent to another doctor who performs eye surgeries. He confirmed that I have narrow angles and scheduled me for an iriodotomy in my left eye and then 3 weeks later in the right eye. I called and canceled. I can’t find peace about doing it. I read that of 1000 patients only 50 have narrow angles and of that 50 only 10% develop closed angle glaucoma. That’s a 10% chance. That being the case and reading the negatives on this site and other sites I’ve been researching on of patients who had bad results, only makes the decision easier. I had rather risk 10% (although I know that if you are one of the 10% it is a 100% for you) than to have the surgeries and be left with problems that I didn’t have before. I pray that my decision works out to be the best for me. Neither of the two physicians could answer the question I posed, “Is this medically necessary”?

  • ari

    rarely, the cornea can get scratched from the laser. perhaps thats what caused your symptoms. i have no idea what the “transparent line” is you refer to. it would have zero to do with the laser. your symptoms cannot possibly be permanent.

    not doing the laser in the other eye would be very risky. at the very least, get a second opinion and have it done elsewhere.

  • Diana Maberry

    I had laser iridotomy on my right eye 5 days ago. Prior to surgery, I have had open angle glaucoma for many years and well controlled at 13 in each eye. On last appt., dr said he saw signs that indicated that I might develop closed angle glaucoma and recommended that I have the procedure on both eyes. Ever since the surgery, I have a white, transparent line in the lower part of my eye and a lot of sensitivity to light. My former great vision is now very blurred. I doubt I will be able to read past the first line on an eye chart. 3 days after surgery, I felt extreme swelling. So the dr met me in his office on the weekend and said my issues were from inflammation and dry eyes. He prescribed 10 days of Neomycin and Polymyxin B and Dexamethasone. 3 days of these drops and I only feel more irritated and my vision is not any better. I am supposed to have a check up next week and have the other eye done. There is no way I want to go through that with my vision the way it is now. I am very worried that this is permanent.

  • ari

    i cannot possibly explain blurred or damaged vision after iridotomy. it makes no medical sense to me- sorry.
    if you have narrow angles at risk for closure, drops may lower your pressure but will not protect you against an angle closure attack. to decline iridotomy in the face of narrow angles at risk for closure would be an enormous gamble and an enormous mistake, for once you get an attack, you are at great risk of blindness. i would demand the laser if i were the patient.

  • Marylee Taylor

    June 2010, I had an iridotomy on both eyes. My pressure was 32 & 36 and my doctor told me I had narrow angles.The night before the procedure I researched and found positives and negatives which made me very leary. The morning of the procedure I was very nervous, but one of the nurses told me she had it done and had no side effects so I felt a little bit better about it.

    After each procedure, I had such blurred vision, I could not see to drive. I was told the vision would clear up. It never did. Both eyes are blurred now. My vision in both eyes has been damaged and I would never do this again. I have had multiple prescriptions for glasses from 4 different doctors in order to be able to see without a blurr and I still have problems seeing well.

    Before the iridotomy’s I had excellent vision. Only needed readers because I’m in my 50’s.

    I wish I had tried drops first to lower the pressure. I use drops 3 times a day and my pressure is stable at 17 & 18. I am sooooooooo sorry I had the procedure and hope there is something that can be done to reverse the damage.

  • Peter

    I had an iridotomy on my left eye Dec.15 2011 and the right eye a week later at the age of 73.
    The operation was only a minor discomfort and was over in a few minutes.
    I was able to drive home with no vision impairment and to this day I would never
    know anything was done to my eyes .The follow up inspection showed all is
    a success. I regret that I almost cancelled the procedure after reading all the
    horror stories on the web but glad Idid’nt…All I can say is make sure your surgeon is reputable and has had a lot of experience with this procedure

  • ari weitzner

    one iridotomy per eye at 3 or 9 oclock. no change in technique needed- just to aim at 3/9 instead of 12. this idea has been discussed in a few articles in the less rigorous “throwaways”. im sure your surgeon can look into it if not familiar.

  • Zuli

    I was scheduled for bilateral prophylactic iridotomies, because I have narrow angles.
    My doctor told me about lines in my vision after this kind of surgery.
    I started doing some research and found even more horrible side effects and canceled my appointments.
    Now I found this website and information about the most current medical research about 3:00 and 9:00 positioning. Ari told about it in the October 18th, 2011 9:27 am post and Brill on October 19th, 2011 7:02 pm.

    Could you, please, give me answers to my few questions, if possible.
    – When you say “iridotomies at 3/9:00” do you mean two wholes (in 3:00 AND in 9:00) or just one whole (just in 3:00 or just in 9:00)?
    – Is this method known among medical doctors? I am living in Canada and thinking if our doctors know and use it. Are there the publications about this research?

    If Brill still visit this website could you please give us a reply about your situation now? Hope everything is good.
    Thank you.

  • Brill

    I had an adverse reaction to a medication on two separate occasions, the second worse than the first, that caused my left eye to experience blur and halos. Both episodes self-resolved within 24 hours. I reported to my optometrist who felt I had narrowed angles. A visual field exam was normal as was the optic nerve. I was referred to an ophthalmologist who confirmed narrow angles but otherwise healthy eyes. He scheduled me for bilateral prophylactic iridotomies. I started doing some research and found all the horror stories and canceled my appointments. My optometrist scolded me. I did more research and found a glaucoma specialist for a second opinion. She confirmed the emergent need for iridotomies. I shared my concerns and asked her for her track record. We even discussed the most current research that Ari mentioned in the October 18th, 2011 9:27 am post. We agreed to the 3:00 and 9:00 temporal positioning. Since she began doing iridotomies in 2001, she has had only one patient that has visual disturbances severe enough that she feels her quality of life is affected. With much fear and trepidation, I had my first procedure on 10/3 and the second on 10/10. At this point in my recovery, I have NO visual aberrations, only some sensitivity to bright light. I am told this is normal for about 2 – 3 months. My friend who is a cataract surgeon and instrumental in my decision to go forward with the procedures, said that I was very lucky that my two episodes of probable angle closure self-resolved (very unusual) and that I had definitely dodged a bullet and disarmed a bomb that was sure to go off in the future resulting in visual loss. I wish more people with positive experiences would post them, so that those of us who are researching wouldn’t be so scared to death! I am so sorry for those whose experiences did not result in good outcomes. But my friend the surgeon mentioned that for those who have experienced severe visual disturbances, one should look into corneal tattooing. Also, I believe in questions, questions, questions, second opinions, experts in the field, and looking into a physician’s statistics and outcomes. I did not connect with the first ophthalmologist; he did not invite conversation even when I expressed my concerns and anxiety. I think it is important for patients to feel they can talk to their caregiver; not do as they are told. I am so happy to have this experience past me. I pray that the iridotomies do not close as I would not care to repeat the experience. But to anyone who is looking for information, please do not be put off by the negativity; be responsible for your own health; do your homework and choose someone with a positive track record. Even ask to speak to someone who has had a positive experience.

  • ari

    we do not do iridotomies for high pressure. so of course your pressure was normal prior to the laser. we do it for narrow angles, which (esp. if you are dilated) can lead to angle closure glaucoma, a serious, painful, blinding condition.
    light rays entering the eye after iridotomy is rare. the risk is far outweighed by the benefit of avoiding angle closure.
    lately, there has been good data to suggest that if we perform the iridotomy at the 3/9:00 position, this rare complication can be avoided (we usually put it at 12:00, where we figured the upper eyelid will cover it and avoid this issue. turns out that the tear film meniscus (where the lid meets the eye) acts like a prism, bending light up towards the iridotomy. i know a colleague who performed literally thousands of iridotomies at 3/9:00 and never had a problem, even though we were taught in residency never to put it there, lest light enter the eye and cause glare. classic counter-intuitive. so i now place it at 3/9:00, too.

  • Tony Carr

    Seems as though the more I look into this the more horror stories I find. I to had the iridotomy performed in both eyes my left eye first. That same day I was (and I am still ) seeing 2 white lines across my eye. After going to my Opthamologist for an emergency checkup he assured me this was a floater from the procedure and it would go away as the gel inside the eye settled so feeling a bit comforted I had the second eye done. Its been 2 months and I still have the lines and i get constant headaches which I rarely used to get headaches before and now i am very sensitive to light. Come to find out my opthamologist actually works for the eye group he sent me to for surgery which he stated i needed asap because my pressure was so high he couldnt even dialate it to finish my checkup which at the time was at 19 and up to 22 is considered normal (which i didnt know at the time
    ). At the time of surgery my pressure was at 14 after the surgery it was at 20. Come to find out all i really needed was eye drops and a yearly check up to keep it in check this I found out from a glaucoma specialist after the fact who I went to after finding out my opthamologist may have had different priorities. The specialist also told me that usually they make a pin hole in the retina, in my right eye it was a pinhole but in the 1 with the lines he said it was more like a tear and that the light was seeping in from it being so large. So all in all if your doctor tells you you need this procedure go to get another opinion if you can afford to. Dont make the same mistake as me. What i really found comical about this, is a site i found where they posted a video on this procedure which people were posting so much negative feedback (all these posters being former iridotomy treatment patients) that the moderator closed the boards because of negatve feedback from all of the former patients. Well maybe if we were a little more informed before hand about possible risks and or side effects and other tereatment options less of us would have this dangerous procedure done.

  • ari

    very very strange and unusual inflammatory reaction to a laser iridotomy. dont make any decision until the doctor has evaluated you. perhaps a second opinion would be helpful here if things dont resolve soon.

  • Rita

    I was scheduled for implantable contact lens (ICL) surgery and had a laser iridotomy done last week. Since then my right eye was in pain and I postponed my surgery till next week. I am on steroid medications for inflammation and now my eyes are so sensitive to light and I do feel like they are burning, probably a side effect from medications. I’ve tried putting my contacts back today and the pain and pressure made it impossible to wear after half a day. I am going to my eye doctor tomorrow and definitely canceling my ICL surgery. I’ve never had such a discomfort in with my eyes before. Will my eyes be the same again? Will I be able to wear my contacts again with those laser holes left in my eyes? I am so devastated…

  • ari

    corneal tatto not a bad option- agree to first try colored contact lens to confirm.
    the pi has nothing to do with dry eye. theoretically, the shock wave of the laser could aggravate the fuch’s, but that would be highly unusual and i doubt it very much.

  • Terry

    I also had a personal injury. I really only have vision in one eye so we did the bad one first….everything went fine. Not so lucky with the good. After I had discomfort in the eye, dry eye and intermittent ghosting. Very very frustruating. After two years of going to doctors I found that the ghosting can be caused by refraction of light – light getting in the PI hole and creating havoc. I found a doctor who has done corneal tattoos with great success. Although this sounds crazy it also makes sense. It sort of puts a sunglass over the hole. I am not a candidate for this yet as I now have other eye issues. He tried to see if this would be successful with a simple brown eye colored contact. If it works then perhaps this option might help. My cornea doc is pretty conservative as well. My issues are all corneal related now. I am convinced that the laser caused issues but every doc swears it hasn’t. What I am told is undetected underlying conditions actually flared after the PI (like dry eye and fuchs) causing my distress. I am glad I did this to preserve my sight however, I have not had any eye issues that caused me symptoms until I did this. I also have a plateau iris so the PI isn’t as optimal as hoped. Good news is on good days I have not lost vision.

  • ari weitzner

    corneal edema should resolve- usually not a problem in straightforward cases. if your symptoms are due to the iridotomy, it is possible to close it with surgery. Speak with your doctor.

  • Tina

    I recently had surgical iridectomy and an ICL implant (for myopia). I am experiencing the same symptons as the previous patient. My vision is now very poor in this eye and was told I had corneal edema. I now also have the white lines, terrible ghosting and glare worse in the daytime. I would not feel safe driving at night as every headlight is miltiplied by three!

    The iridotomy holes are large and not near the edge of my iris but close to the pupil. Will this improve with time? I am not having the other eye done until I can see clearly from this eye.

    I wish I had put up with my myopia and stuck with my contact lenses and thick glasses now – whats more I have spent £5200 for this terrible outcome!

  • ari

    yeesh! side effects are so rare after iridotomy. i’m shocked it was so painful and your pressure went up.
    the glare may be due to the high pressure in the eye which can make the cornea a little irregular (microcystic edema), or, from the iridotomy itself. if from the iridotomy, there’s not much you can do except go to the operating room and have it closed. but it’s almost unheard of to have a patient so miserable from iridotomy that they would need to do that.
    the pressure can rarely go up chronically after the iridotomy if the iridotomy releases a lot of pigment which clogs up the drain (the trabecular meshwork). that would only happen in a dark-pigmented iris where the iridotomy was difficult and required a lot of laser; blue irides liberate so very little pigment.
    since your experience is so rare, i advise strongly you see a glaucoma specialist for an opinion.