Treatment - Glaucoma

There are several different treatments for glaucoma, including eyedrops, laser treatment and surgery. The best treatment for you will depend on your circumstances.

Treatment can't reverse any loss of vision that has already occurred, but it can help stop your vision getting any worse.

Your treatment plan

Your treatment will largely depend on which type of glaucoma you have. The most common type, primary open angle glaucoma, is usually treated with eyedrops. Laser treatment or surgery may be offered if drops don't help.

Treatment for other types of glaucoma may include:

• primary angle closure glaucoma – immediate treatment in hospital with medicine to reduce the pressure in the eye, followed by laser treatment
• secondary glaucoma – eyedrops, laser treatment or surgery, depending on the underlying cause
• childhood glaucoma – surgery to correct the problem in the eye that led to the build-up of fluid and pressure

You'll also be advised to attend regular follow-up appointments to monitor your eyes and check that treatment is working. It's important not to miss any of these appointments.

The main treatments are described below.

Eyedrops

Eyedrops are the main treatment for glaucoma. There are several different types that can be used, but they all work by reducing the pressure in your eyes.

They're normally used between 1 and 4 times a day. It's important to use them as directed, even if you haven't noticed any problems with your vision. Your sight is at risk if you don't stick to the recommended treatment.

You may need to try several types before you find the one that works best for you. Sometimes you may need to use more than one type at a time.

Eyedrops can cause unpleasant side effects, such as eye irritation, and some aren't suitable for people with certain underlying conditions.

How to apply eyedrops

Wash your hands before and after applying the drops. To apply eyedrops:

• use your finger to gently pull down your lower eyelid
• hold the bottle over your eye and allow a single drop to fall into the pocket you have created in your lower eyelid
• close your eye and keep it closed for a few minutes

If you're using different types of eyedrops, allow at least 5 minutes between using the different types.

After you have put in the eyedrops, gently press in the inside corner of the eye (over the eyelid) for about a minute. This reduces the drainage of the eyedrop from the eye, which helps to increase its effect. It also helps to reduce any side effects.

Laser treatment

Laser treatment may be recommended if eyedrops don't improve your symptoms.

This is where a high-energy beam of light is carefully aimed at part of your eye to stop fluid building up inside it.

Types of laser treatment include:

• laser trabeculoplasty – a laser is used to open up the drainage tubes within your eye, which allows more fluid to drain out and reduces the pressure inside
• cyclodiode laser treatment – a laser is used to destroy some of the eye tissue that produces the liquid, which can reduce pressure in the eye
• laser iridotomy – a laser is used to create holes in your iris to allow fluid to drain from your eye

Laser treatment is usually carried out while you're awake. Local anaesthetic drops are used to numb your eyes – you may just feel a brief twinge of pain or heat during the procedure.

You may still need to use eyedrops after having laser treatment.

Surgery

Surgery may be recommended in rare cases where treatment with eyedrops or laser haven't been effective.

The most common type of surgery for glaucoma is called trabeculectomy. It involves removing part of the eye-drainage tubes to allow fluid to drain more easily.

Glaucoma surgery may be carried out under local anaesthetic (while you're awake) or general anaesthetic (while you're asleep).

Most people won't need to take eyedrops any more after trabeculectomy, and you shouldn't be in a lot of pain after surgery.

Your doctor should discuss which type of surgery they recommend, as well as any risks and benefits, before you decide whether to go ahead.

Other types of glaucoma surgery include:

• trabeculotomy – similar to a trabeculectomy, but an electric current is used to remove a small part of the eye-drainage tubes
• viscocanalostomy – part of the white outer covering of the eyeball (the sclera) is removed so fluid can drain from your eye more easily
• deep sclerectomy – the drainage tubes in your eye are widened, sometimes by implanting a tiny device inside them
• trabecular stent bypass – a tiny tube is placed into your eye to increase the drainage of fluid

After surgery, your eye might water and be red, and your vision may be slightly blurred for up to 6 weeks but should return to normal.

The hospital will give you advice about which activities you can do while you recover. Most people are advised to keep their eye dry, and avoid driving, reading and heavy lifting for at least a week.