Glaucoma: Types of Surgery

What is glaucoma?

Glaucoma is an eye disease in which the nerve that carries visual messages to the brain (optic nerve) is damaged. This is usually caused by high pressure inside the eye. Damage to the optic nerve can cause a permanent loss of vision. Glaucoma needs to be diagnosed and treated early to prevent blindness.

Normally, the fluid in the front of the eye is constantly flowing from where it is formed (the ciliary body) to the front of the eye. This fluid nourishes your eye and helps to keep its shape. The area between the iris (colored part of the eye) and the cornea (the clear outer layer on the front of the eye) is called the angle. Fluid drains out through the angle, into drainage channels, and is then reabsorbed by the body. When fluid flows out too slowly, eye pressure builds up.

In open-angle glaucoma, fluid drains slowly, causing the pressure in the eye to increase. This happens even though the drainage channel for the fluid is open.

In angle-closure glaucoma, the angle between the iris and the cornea is blocked or narrowed. When this happens, fluid is not able to drain from the eye. This can cause a pressure buildup.

What are the different types of surgery for glaucoma?

Surgery involves either using a laser or making a cut in the eye to reduce the pressure in your eye. The surgery is done to try to prevent further vision loss. It does not make your vision better.

The type of surgery you have depends on the type and severity of your glaucoma and other health problems you may have. Surgical procedures to treat glaucoma are:

• Laser trabeculoplasty: The provider uses a laser to increase the fluid drainage from the angle where the iris and cornea come together. This procedure is used to treat some kinds of open-angle glaucoma.
• Laser iridotomy: The provider uses a laser to make a small hole in the iris to allow fluid to drain and reduce pressure in the eye. Many cases of angle-closure glaucoma can be treated with laser iridotomy.
• Filtering surgery: The provider creates a small passageway from the inside to the outside of your eye. This helps fluid drain better from your eye. The most common type of filtering procedure is called a trabeculectomy. This type of surgery is used for several types of glaucoma.
• Shunt procedure: The provider places a tube inside the eye. The tube helps the fluid drain from the eye. This surgery is used for several types of glaucoma.
• Cyclodestructive procedures: These procedures use freezing or a laser to reduce the amount of fluid an eye can produce. It destroys part of the eye that makes fluid. This kind of procedure is usually used as a last resort.

What happens after glaucoma surgery?

You may be able to go home the day of the surgery. One or both of your eyes may be bandaged. You will not be able to see through the bandages and you will need to arrange for someone to drive you home. If one eye is bandaged, you may notice changes in your depth perception. Be careful so that you do not fall.

Your eye care provider may give you a prescription for pain medicine. Ask your provider if you should continue using your current eyedrops. Follow your provider's instructions for using eyedrops or ointment to prevent infection and reduce inflammation and scarring.

After surgery, your provider may want you to use an eye patch or shield to protect your eye from injury. Do not rub your eye unless your provider tells you to massage your eye.

The provider may need to examine your eye and measure the pressure the day after surgery.

Ask your healthcare provider:

• how long it will take to recover
• what activities you should avoid
• how to take care of yourself at home and when you can return to your normal activities
• what symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup.