The procedure is a last resort, as considerable inflammation can occur, it is associated with some discomfort, and it includes the risk the eye may lose critical circulation and or sustain too much damage to the ciliary body and not be able to make fluid at all. If this occurs it will cause the eye to involute, or shrink, with total loss of vision. The loss of vision at low or normal eye pressure makes this group very difficult to treat. Aggressive intervention using all the modalities of open angle glaucoma patients described above is necessary. Filtration surgery may need to be performed at a relatively early stage for many of these patients who do not respond to more conservative treatment.
Treatment Recognizing a narrow angle problem before an acute angle closure attack is key.
Attacks can sometimes be broken using eye drops. Otherwise laser treatment is possible if the cornea is not steamy, or can be cleared with special eye drops. Similar to the laser illustration below, a surgical opening like that at A' can be created. The surgical procedure requires about fifteen minutes to complete. As long as the peripheral iridotomy is not too small and remains open further treatment preventive treatment to protect from an attack is unnecessary.