Glaucoma Treatment

Treatment of glaucoma is geared at lowering the intraocular pressure to prevent further damage to the optic nerve. The level to which the pressure must be lowered is not the same for everyone, but is determined by the initial pressure at the time of diagnosis and the amount of optic nerve damage present.
Medications (eye drops and pills), laser and surgical operations can all be used to control glaucoma. Periodic examinations to reassess the pressure and evaluate the nerve are needed and treatments may be changed over time to obtain adequate pressure lowering.

Glaucoma is usually treated with one or more eye drops taken one to several times per day. Sometimes pills can also be used. There are several different classifications of eye drop medications and they work to lower the pressure either by decreasing the amount of aqueous fluid being made or by improving the outflow of the aqueous. These medications control, but do not cure glaucoma. These medications are usually well tolerated, but they may be costly and, as with all medications, have the potential for side effects.

Narrow angle glaucoma: Laser treatment (laser iridotomy) is typically used to treat and also prevent narrow-angle glaucoma attacks. This type of laser involves making a small hole in the iris to prevent complete blockage of aqueous outflow from occurring. Laser iridotomy in narrow-angle glaucoma may cure the condition.
Primary open angle glaucoma: A laser procedure (trabeculoplasty) is also available to help improve outflow of aqueous in those with open angle glaucoma. This type of laser treatment will often help lower the pressure, but doesn’t work for everyone. Also, the pressure lowering effect my only last for a few years. Sometimes a laser procedure can be done to decrease the amount of medication that is needed.

When medication and/or laser treatments fail to provide adequate decrease in pressure, filtering surgery (trabeculectomy) might be recommended. In this surgery, a small opening is made through the sclera (the white of the eye) allowing aqueous fluid to drain into a small bleb on the surface of the eye. Though rare, surgery has the potential for serious complications and is usually only recommended when optic nerve damage cannot be prevented by other means.