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?”

  • Ann

    I had a bilateral laser iridotomy done in November to prevent closed angle glaucoma. I had no problems following it but for two days now I’ve had headaches feel sick and have a very painfull right eye. It also feels like someone has scratched my eye or I have grit in it. I feel like there’s pressure behind my eye. The headache and nausea is not as bad today but my eye is very painful any ideas? To complicate matters I’ve ms so don’t know what is what

  • ari

    i meant to add that i sympathize with your complaints. but you have to understand that angle closure glaucoma is a difficllt, blinding condition, and the risks associated with iridotomy surely are far outweighed by the benefit of avoiding this dreaded disease. but since i have been reading so many complaints, and the literature now suggests that cataract surgery may be a better long-term option, i think i am going to offer cataract surgery more to my patients.

  • ari

    i dont think i said the side effects were “acceptable”. they are worth the risk considering the benefit–to avoid angle closure glaucoma. you are under the wrong impression- the iridotomy is not to reduce the pressure. it’s to avoid pupillary block angle closure glaucoma. drops cannot be used for this purpose. of course if drops could protect from this condition, we would use it first. drops are useless in preventing angle closure claucoma. i hope thats clear.

    iridotomy cannot make you go from -4.75 to -6.00. cataract can do that, and in fact, cataract explains much of your symptoms you have described.

    if you have narrow angles at risk for angle closure glaucoma and you refuse an iridotomy, i strongly advise cataract surgery-it is equally effective.

  • Rich

    I had the iridotomy a year ago and it’s been very negative for me in terms of my vision. I was to have both eyes done but only had the right one done because the side-effects were terrible. Brighter lights or a bright sunny day are awful now and I avoid going outside in the snow (blinding!) or to the beach (sun and sand are brutal) as a result: my right eye is overexposed like a photograph would be at the wrong f-stop. The untreated left is fine. I close my treated eye a lot now-a-days.

    There is a definite slight double image which is, of course, what would happen if the “camera” had 2 holes for light instead of one (the dominant image from the pupil and a ghost from the smaller hole). Night vision is also effected as a result: untreated left eye can see quickly and perfectly in a dark room; the right treated eye takes longer to adjust and in the end is almost the same but not quite as good at giving me contrast in the deepest shadows: I think this is because of the extra light that is coming through the extra hole making what should be “x” amount of light entering the eye now “x + the hole’s light” causing the deepest shadows to look like they are just charcoal black instead of deepest black (meaning I can’t see the difference between the deepest shadows and the charcoal shadows anymore).

    My formerly vertical astigmatism (which I could make better by squinting and was the same in both eyes so it really worked well) is now oblique meaning the angle of the astigmatism (direction of the blurring) in the treated eye changed to be diagonal while the untreated eye is vertical so squinting no longer helps and makes for some pretty bad vision when the glasses are off when the now very different images from the 2 eyes are sent to my brain. Also the -4.75 I was in each eye is now different: -4.75 in the untreated eye and -6.00 or so in the treated. Again, pretty bad vision without the glasses.

    Lastly, the pressures haven’t come down in the treated eye so it was all for nothing in correcting my problem. Overall, big mistake to have this done and I recommend choosing the drops or some other treatment until there is something better. I see Ari’s answers and note that the side effects are seen as acceptable. They are not in my opinion. Avoid this procedure if possible and get a second and third and forth opinion before doing it. I would even go so far as to keep getting the thickness of your retinal tissue checked often and only have something done if there is a noticeable change (beginning of tissue death) showing that you personally cannot take the high pressures. Everyone has a different threshold. I’m hoping that I can wait out the narrow angle problem which my doctor says could happen if my lens thickens enough to stop the pigment from shedding from my iris due to the rubbing. We’ll see how it does but I can’t say enough how sorry I am for having had this procedure. I’m 38 now and thank God for having had 37 years of great vision: the next 37 are going to be much tougher but I have hopes that maybe a contact lens that covers the hole and not the pupil will be made. At least the double vision will go away then and the astigmatism blur will be gone and the -6.00 vision correction can take place – but that overexposure pain can’t be fixed without sunglasses; even then though, the image has no detail in the highlights. It’s darker overall so it’s not painful. That part sucks but I will have to live with it I suppose.

  • ari

    your experience is typical. side effects are rare.

  • Joe

    Sorry – I meant………. “the right eye should be done there and then”

  • Joe

    I am 66. At a routine eye examination I was found to have high intraocular pressure and was refered to a specialist via my GP. I saw him two weeks ago (1 Feb) and my IOP results were L36 and R19. Following examination he told me that I had narrow angles and recommeneded that I have a laser iridotomy in my left eye ASAP because of narrow angle glaucoma and in my right eye as a preventative measure. He explained that without treatment there was a 50% chance my right eye would also develop narrow angle glaucoma. He immediately prescribed pressure lowering eye drops and an appointment was made for me to have the procedure today (15 Feb). The surgeon suggested that if after the left eye was done I was comfortable and there were no side effects he could do the right too. Because I was able to hold my left eye still without any difficulty he did not need to use the contact lens and was able to make the hole with one shot of the laser. As it seemed to go OK we agreed that the left eye should be done there and then. Again it was completed with one firing of the laser. I hardly felt any sensation and I am now at home some seven hours after the procedures were carried out with seemingly no side effects. Whilst there are some that go bad – as there are with most surgical procedures – it seems that statistically it is a very safe proscedure and that is my experience thus far. I must admit, however, to have the same reservations that others have experienced and spent many hours reading any number of websites looking for comforting reports only to find many worrying reports and then experiencing sleepless nights as a result. I would guess that if all goes well most people would not think to post it on a website such as this – so I think there must be a multitude of happy endings out there which we never hear about. I am so sorry for those who had a bad outcome but do hope my experience is of some comfort to any who are uncertain about whether to proceed or not. 🙂

  • marilyn

    I’m 71, developed “narrow angle glaucoma”…the specialist followed me for several yrs,re the pressure, and i also developed a left cataract.he needed to do the laser in order to dilate to view the cataract.
    I’m happy and relieved to share that i had none of the side effects mentioned so far, except occasional “eyeball” brief aching,now and then.
    no changes in colors, no lines, no headaches,thankfully.
    However,i’m very sorry i had them done,and will always wonder if they were necessary, because this is irreversible…
    The Dr did wait years,patiently,until I was ready..I had both eyes done, 6 months apart..
    best of luck to everyone..its so hard to trust a Doctor where your permanent vision is concerned, and can be altered forever…
    I now have to have cataract surgery on my left eye…blurring way before the iridotomy,so not related …

  • Sandy

    I had a very positive experience with laser iridotomies. I went to a very specialized eye surgeon to see if I had Fuch’s Dystophy as my older sister has it. During the exam he found I had narrow angles. He monitered the narrow angles for several months and because they were getting more narrow, he wanted me to have the laser procedure. To me, it was a choice of maybe losing my eyes or the laser iridotomies. He did one eye over a year ago. For four months he checked it to see how it was going and to make sure the hole stayed open. Also, he used the smallest hole necessary. At first the hole closed up, and he has to open it again. But then it stayed open, and four months later he did the other eye. I have to admit that I was nervous, but it was only a little painful during the procedure. I am extremely glad I had it as now I don’t have to worry constantly that I could not only lose my vision from narrow angles, but maybe an eye. My advice is to make sure you find a doctor who is more than an ophthalmologist. They should be an eye surgeon who has had lots of experience doing this procedure. And do have a second opinion if you have doubts.

  • ari

    side effects are rare. if you dont get the laser, and you end up in angle closure, you will be very, very sorry. driving a car is much more dangerous than laser. go to a glaucoma specialist and ask how narrow your angles are, if you want reassurance.

  • Elsa

    My mother had an acute narrow angle attack when she was in her 70’s, my sister was diagnosed with narrow angles and has had preventative iridotomies with no permanent side effects. I have received numerous opinions on whether or not I have narrow angles; about half the doctors say yes the other half say no. My pressure is 14 in both eyes. I recently moved and am now going to a new Ophthalmologist who is pressuring me to get iridotomies, because of the family history.

    Can anyone tell me what the percentage is of people who end up with mild to serious side effects? It is a very hard decision to make, since my vision is good and my eyes are healthy and it doesn’t seem that the doctors can agree on how narrow my angles are. I want to make sure the research shows that the side effects are as low as the doctor is claiming.

  • gwen

    I had iridotomies done half a year ago and am still suffering from glare, ghost images and bright white lines across my nose. Now I have to avoid looking at windows, cross the road at night, or even going into the kitchen because the ghost images from the shiny stainless steel utensils hurt my eyes. I get headaches more often. After two follow up consultations, my doctor still insisted that she’s done thousands of iridotomies but had not come across such symptoms. I’m already wearing glasses with polarised and tinted lenses but the disturbances only alleviated slightly. Only when I put on my Ray Ban sunglasses will the ghost images, glare and white lines reduce to the minimum. I found that the symptoms increased in intensity after I was given medication to dilate my pupils for the doctor to examine my eyes. I also found that if I close my right eye, the ghost images cut down or disappear.

  • joyce

    I had my second iridotomy done for my right eye. This time it took a little longer for the procedure and I felt a slight pinching but nothing that hurt. I will be having a pressure check in 3 weeks. I had no after effects from either procedure. Good luck to everyone.

  • ari

    one does not need a specialist for this procedure. a first year resident could do it.

    there is evidence to suggest that having it done superiorly under the lid carries a higher risk of side effects. i no longer do it superiorly. a recent article in the journals suggest it makes no difference.

    one could get a second opinion if one has doubts about the need for the laser.

  • Matt

    I just had laser iridotomy in both eyes (2 weeks apart) due to narrow angles. My pressure went down immediately, and light sensitivity went away. I didn’t feel a thing in my right eye during the procedure, but had a couple sharp pinches in the left (may not have been numbed as much). I do have a very slight hairline glare (more in the right eye) depending on how the light hits the eye. I only notice it when watching TV if I sit a certain way, or sometimes in bright sunlight (sunglasses takes care of it). I have had no change in vision other than that. I was diagnosed by my eye doctor, referred to an opthamologist, and got a second opinion. I found a guy who specializes in this procedure and works out of an eye center within a hospital. The hole is SUPPOSED to be pin sized and covered by the eyelid. If anyone is looking to have this treatment done, I would HIGHLY recommend doing your research and finding someone who specializes in this procedure. If done correctly, the benefits definitely outweigh the risk of blindness, which can occur over time with narrow angles if left untreated.

  • joyce ireland

    I have narrow angles and 1 week ago I had an iridotomy. There was no pain at all during the treatment and no pain after. During the procedure I saw a red light and heard a clicking sound. The remainder of the day I felt like I had water in my eye but the next day all was clear. I will be having the other eye done one week from today. I just wanted to share my positive experience.

  • ari

    iridotomies only rarely cause problems. the benefit is great, as it prevents angle closure glaucoma. driving a car is riskier than iridotomies, yet you dont think twice about driving in a car. get a second opinion, and have them done.

  • olga

    I am wondering if somebody had a positive experience with iridotomies?
    What I can understand- iridotomies cause a life-long disability. They cause an endless chain of problems- seeing lines, gosts, double-vision, cataract-growth, they provoke open-angle glaucoma and bullous keratopathy.
    It lookes like this procedure causes such a terrible damage. Why do the doctors insist on it?
    It is usually done when a vision is still good and maybe can stay good for a while, but becomes terrible after the iridotomy.
    God help me to decide what to do. The doctors say I need iridotomies, but I still have 9 years before retirement. How will I be able to survive if the iridotomies deprive me of my vision?

    Could somebody share about his positive experience?

    Thank you and God bless you.

  • olga

    I am wondering if somebody had a positive experience with iridotomies?
    What I can understand- iridotomies cause a life-long disability. They cause an endless chain of problems- seeing lines, gosts, double-vision, cataract-growth, they provoke open-angle glaucoma and bullous keratopathy.
    It lookes like this procedure causes such a terrible damage. Why do the doctors insist on it?
    It is usually done when a vision is still good and maybe can stay good for a while, but becomes terrible after the iridotomy.
    God help me to decide what to do. The doctors say I need iridotomies, but I still have 9 years before retirement. How will I be able to survive if the iridotomies deprived me of my vision?

    Could somebody share about his good experience?

    Thank you and God bless you.

  • olga

    Mrs. Cleveland,

    Did you have your iridotomies? I was also diagnosed with narrow angles in August, 2012 and I need iridotomies. After reading the comments, I cannot sleep and am terribly nervous because I am scheduled to have the first iridotomy in the middle of November, 2012. I would like to cancel it because now my vision is good with glasses, but my understanding is it will be really terrible afterwards.

    I would like to know what you have decided. I am torn apart by doubts and would like to cancel my appointment for the seconf time.