Glaucoma surgery overview

Overview

Glaucoma is an eye condition where the pressure inside your eye becomes too high, which can damage the optic nerve (the cable that sends images to your brain). Surgery for glaucoma aims to lower this pressure to protect your sight.

Glaucoma is one of the most common causes of blindness worldwide. Surgery is less common than eye drops, but many people need it eventually.

It mainly affects older adults, but can occur at any age. People with a family history of glaucoma, African or Caribbean heritage, and those with certain medical conditions (like diabetes) are at higher risk.

Symptoms

Common symptoms

• Many people with glaucoma have no symptoms at first.
• Gradual loss of side (peripheral) vision, often in both eyes.
• Seeing halos around lights or blurred vision.

Symptoms in children

• Watery eyes, sensitivity to light, or a cloudy cornea (the clear front part of the eye).
• One eye may appear larger than the other.
• Frequent eye rubbing or squinting.

Symptoms in older adults

• Slow, painless loss of vision starting from the sides.
• Difficulty adjusting to dark rooms or seeing at night.
• Needing brighter light for reading or seeing details.

Causes

Main causes

• The main cause of glaucoma is a buildup of fluid inside the eye that increases pressure. The fluid normally drains through a mesh-like area, but in glaucoma, that drainage system gets blocked or doesn't work well.
• Surgery addresses this by creating a new way for the fluid to drain, lowering the pressure.

Risk factors

• Being over 40 years old.
• Having a family member (parent, sibling, child) with glaucoma.
• Having high eye pressure even without vision loss.
• Being very nearsighted or farsighted.
• Having certain medical conditions such as diabetes, high blood pressure, or sleep apnea.
• Prolonged use of corticosteroid medications (steroids).

When to see a doctor

See a doctor urgently if:

• If you have sudden eye pain, vision changes, or see halos around lights, seek same-day care or call your local emergency number.
• If you have had glaucoma surgery and notice sudden pain, vision loss, or discharge from the eye, contact your surgeon immediately.

Book a routine appointment if:

• If you are over 40 and haven't had an eye exam in 2 years, schedule one.
• If you have a family history of glaucoma, get a baseline eye exam by an optometrist or ophthalmologist (eye doctor) after age 30.

Diagnosis

Glaucoma is diagnosed through a series of eye tests. Your eye doctor will check the pressure inside your eye, examine the drainage angle, look at the optic nerve, and test your side vision.

Tests that may be done

• Tonometry: a device that measures the pressure inside your eye (intraocular pressure).
• Ophthalmoscopy: the doctor uses a special lens to look at your optic nerve for signs of damage.
• Perimetry (visual field test): you look into a machine and press a button when you see lights in your side vision.
• Gonioscopy: a contact lens is placed on your eye to examine the drainage angle.
• Optical coherence tomography (OCT): a scan that takes detailed pictures of your optic nerve and retina.

What to expect at your appointment

The tests are painless and do not require any preparation. You may have eye drops to dilate (widen) your pupils. The whole appointment usually takes about an hour. You will be able to discuss results and next steps with your doctor.

Treatment

Treatment for glaucoma aims to lower eye pressure to prevent optic nerve damage. Options include eye drops, laser procedures, and surgery. Surgery is usually considered when other treatments haven't controlled the pressure.

Self-care at home

• Take all prescribed eye drops exactly as instructed, even if you feel fine.
• Keep all follow-up appointments to monitor your eye pressure and optic nerve.
• Avoid rubbing your eyes, especially after surgery.
• Wear sunglasses outdoors to reduce glare and protect your eyes.

Medical treatments

Doctors often start with eye drops that help reduce the amount of fluid your eye makes or help it drain better. If drops aren't enough, a laser treatment (such as selective laser trabeculoplasty) may be used to improve drainage. For more advanced cases, surgery like trabeculectomy or a drainage implant may be recommended. The specific treatment plan is tailored to your eye condition and overall health.

When is surgery considered?

Surgery is usually recommended when eye drops and laser treatments have not lowered the eye pressure enough to prevent further nerve damage, or when side effects from medications are too bothersome. Your eye surgeon will discuss the best type of surgery for your situation.

Living with this condition

After glaucoma surgery, you may need to take it easy for a few weeks. Your doctor will give specific instructions about activities like bending, lifting, and swimming. You will likely need to use antibiotic and anti-inflammatory eye drops for a while. Most people return to normal activities within a month.

Lifestyle tips

• Protect your eyes from injury by wearing safety glasses during sports or home projects.
• Avoid heavy lifting, straining, or activities that increase pressure in your head (like playing brass instruments) until your doctor says it's safe.
• Sleep with your head elevated on two pillows if you had certain types of glaucoma surgery.

Diet and exercise

A healthy diet rich in fruits and vegetables may support overall eye health. Regular, moderate exercise like walking or swimming can help lower eye pressure, but check with your surgeon before resuming intense workouts. Avoid exercises that involve inversion (like yoga headstands) or heavy lifting.

Mental health and emotional wellbeing

Living with glaucoma and facing surgery can cause anxiety or worry about vision loss. It's normal to feel stressed. Talk to your eye care team about your concerns. Many people find that staying involved in hobbies and social activities helps them cope.

Prevention

Glaucoma itself cannot be prevented, but early detection and treatment can prevent severe vision loss. Regular eye exams are the most important step.

Screening programmes

Routine eye exams are recommended every 1–2 years for adults over 40. People with risk factors (such as family history or African heritage) should start earlier. The exam includes pressure checks, optic nerve examination, and visual field testing if needed.

Complications

If left untreated

• Gradual and permanent loss of peripheral (side) vision.
• Tunnel vision (only seeing straight ahead).
• Complete blindness in the affected eye.

Long-term outlook

With timely treatment, most people with glaucoma can preserve useful vision for life. Surgery is highly effective at lowering eye pressure and slowing progression. Even if some vision is lost, the remaining sight can often be stabilized. Ongoing care and monitoring are essential for the best outcome.

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