Glaucoma Treatment (Laser/Surgery)

Glaucoma treatment by laser or surgery is a set of procedures that lower the pressure inside the eye to prevent the optic nerve (the nerve that carries vision signals to the brain) from being damaged further.

In glaucoma, fluid builds up inside the eye and raises the intraocular pressure (pressure inside the eyeball). Over time, this pressure squeezes and slowly destroys the optic nerve, causing vision loss that cannot be reversed. Laser treatment works by improving the eye's natural drainage channels so fluid can escape more easily. Surgical treatment creates a new drainage pathway or reduces the amount of fluid the eye produces. Both approaches aim to bring pressure down to a safe level and protect whatever vision remains.

These procedures are used when glaucoma cannot be controlled adequately with eye drops or oral medication alone. The goal is always to reduce eye pressure enough to slow or stop further optic nerve damage. The specific procedure chosen depends on the type of glaucoma, how high the pressure is, and how much optic nerve damage has already occurred.

• Open-angle glaucoma (the most common type, where the drainage angle is open but works too slowly) that is not responding well to drops.
• Angle-closure glaucoma (where the drainage angle is blocked or very narrow), often treated urgently with laser.
• Normal-tension glaucoma (where the optic nerve is damaged even though pressure seems normal) when further pressure reduction is needed.
• Secondary glaucoma caused by another eye condition, such as uveitis (inflammation inside the eye) or a previous eye injury.
• Congenital glaucoma (present from birth) in infants and young children who cannot use drops effectively.
• Patients who cannot tolerate or consistently use glaucoma eye drops.

Laser or surgical treatment may not be recommended in certain situations. Your eye doctor will assess your individual case carefully.

• Active eye infection or severe inflammation inside the eye — the eye must be treated and stable first.
• Very advanced glaucoma where virtually no useful vision remains — the risk-benefit balance may not favour surgery.
• Certain corneal conditions (problems with the clear front surface of the eye) that make laser less effective.
• General health conditions that make any form of surgery unsafe — your overall health will be reviewed.

Laser treatment for glaucoma carries relatively few risks and is generally well tolerated; surgical procedures carry a broader range of possible complications, which your surgeon will discuss with you before you consent. Risks include:

• Temporary rise in eye pressure shortly after the procedure — this is common after laser treatment and is usually managed with extra eye drops.
• Eye redness, irritation, or mild discomfort in the days following treatment.
• Blurred vision for a short period after laser or surgery.
• Infection inside the eye (endophthalmitis) — rare but serious; requires prompt treatment with antibiotics.
• Bleeding inside the eye (hyphaema — blood collecting in the front chamber of the eye) — more likely after surgical procedures.
• Scarring of the drainage pathway created by surgery, causing the pressure to rise again over time.
• Cataract (clouding of the lens inside the eye) — can develop or worsen faster after some glaucoma surgeries.
• Low eye pressure (hypotony) — if the drainage works too well, pressure can drop too low, affecting vision.
• Damage to surrounding eye structures during surgery — uncommon but possible.
• The procedure not lowering pressure enough, requiring additional laser sessions, further surgery, or a return to or addition of eye drops.

Preparation depends on whether you are having laser treatment or surgery. Laser procedures are usually done in an outpatient clinic and require minimal preparation. Surgery is more involved and may require an overnight stay. Your eye care team will give you specific instructions tailored to your situation.

Before the procedure, your team will typically ask you to:

• Continue your regular glaucoma eye drops unless instructed otherwise — stopping them suddenly can cause a dangerous pressure spike.
• Inform your doctor of all medications you take, especially blood thinners (such as aspirin or anticoagulants), as these may need to be paused before surgery under medical guidance.
• Avoid eating or drinking for several hours before surgical procedures that require sedation (a calming medication) or general anaesthesia (medication that puts you to sleep). Laser procedures done with only local anaesthetic eye drops usually do not require fasting.
• Arrange for someone to accompany you and drive you home, as your vision will be temporarily affected.
• Remove contact lenses before the procedure if you wear them.
• Tell your doctor about any allergies, recent illnesses, or current infections.

Tests and assessments usually done before the procedure include:

• Tonometry (measurement of the pressure inside your eye).
• Gonioscopy (examination of the drainage angle of the eye using a special contact lens).
• Visual field test (a map of your peripheral — side — vision to measure how much has been lost).
• OCT (optical coherence tomography — a scan of the optic nerve and retina to assess damage).
• Corneal thickness measurement (pachymetry), which affects how pressure readings are interpreted.
• General health checks, including blood tests and an ECG (heart tracing), if surgery under sedation or general anaesthesia is planned.

On the day of the procedure, the usual steps are:

• 1. You will be checked in and your eye pressure and vital signs measured.
• 2. Anaesthetic eye drops are put in to numb the surface of your eye. For surgery, additional local anaesthetic injections around the eye or sedation may be used, depending on the plan.
• 3. For laser treatment: a special contact lens is placed on your eye to focus the laser beam. The laser is applied to the drainage area in short, precise pulses. You may see flashes of light and feel mild warmth or pressure — rarely pain.
• 4. For surgical treatment (such as trabeculectomy — creating a small drainage flap — or tube shunt implantation — inserting a tiny drainage tube): the area around the eye is cleaned and draped. The surgeon makes carefully placed incisions (cuts) and creates or implants the drainage pathway. The incisions are then closed with fine sutures (stitches).
• 5. After the procedure, antibiotic and anti-inflammatory eye drops are applied, and the eye is usually covered with a protective shield.
• 6. You rest briefly in a recovery area and are then discharged when your team is satisfied you are stable.

After laser treatment, most patients go home the same day and recover quickly. After surgery, recovery takes longer and requires more careful attention to wound care. In both cases, follow-up eye pressure checks are essential, because the goal of glaucoma treatment is an ongoing one — protecting the optic nerve over the rest of your life.

• Eye drops: antibiotic and steroid (anti-inflammatory) eye drops are usually prescribed for several weeks after surgery to prevent infection and reduce scarring. Glaucoma drops may still be needed, depending on how well pressure is controlled.
• Eye shield: a protective shield is worn over the eye, especially during sleep, for at least the first week after surgery to prevent accidental rubbing or pressure on the eye.
• Activity restrictions: strenuous exercise, heavy lifting, swimming, and contact sports are usually avoided for several weeks after surgery. Laser patients typically return to normal activities within a day or two.
• No rubbing: rubbing the eye can displace sutures or disrupt healing tissue and should be avoided.
• Water and hygiene: getting soap or water directly in the operated eye is usually discouraged until the wound has healed. Your team will advise when it is safe to shower normally.
• Driving: do not drive until your vision has stabilised and your doctor confirms it is safe to do so.
• Follow-up appointments: eye pressure is usually checked the day after the procedure, then again at one week, one month, three months, and at regular intervals afterwards. The schedule varies by procedure and hospital.
• Medication review: your existing glaucoma drops may be adjusted, reduced, or continued, depending on the pressure readings at your follow-up visits.
• Long-term monitoring: glaucoma is a lifelong condition. Even after successful treatment, regular visual field tests and optic nerve scans are needed to ensure the disease is not progressing.
• Warning signs to report promptly: sudden severe eye pain, a sudden significant drop in vision, increased redness, or discharge from the eye should be reported to your eye team without delay.