Surgery for Glaucoma

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What is glaucoma?

Glaucoma is an eye disease in which the nerve that connects the eye to the brain (optic nerve) is damaged. This damage often occurs if pressure in the eye is high. The damage can lead to loss of vision. However, early treatment can prevent vision loss. If you need treatment, your eye care provider may recommend medicine, laser treatment, or possibly surgery to reduce the pressure in one or both eyes.

What are the different types of surgery for glaucoma?

Surgery involves either laser treatment or making a cut in the eye to reduce the pressure in your eye. The type of surgery you have depends on the type and severity of your glaucoma and other health problems you may have. Surgical procedures for the treatment of glaucoma are:

• Laser trabeculoplasty: The surgeon uses a laser to increase the fluid drainage from angle (where the iris and cornea come together). The tissue that drains fluid from the angle is called the trabecular meshwork. This procedure is used to treat some kinds of open-angle glaucoma.
• Laser iridotomy: The surgeon 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 surgeon removes a very small piece of the wall of the eye (the sclera). Fluid can then drain through the hole that this creates. The fluid then collects in a balloon-like pouch on the side of the eye, called a bleb. 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 surgeon 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: In some cases of glaucoma, it may be necessary to destroy certain areas of the ciliary body (the part of the eye that produces fluid). A laser or freezing instrument is used. This procedure is usually used as a last resort.

What happens after glaucoma surgery?

• You will probably 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 use the bandaged eye(s), 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. You will need to be careful so that you do not fall.
• You may have some pain in your eye. Your eye care provider will give you medicine for the pain.
• The provider may need to examine your eye and measure the pressure the day after surgery.

How can I take care of myself?

• Carefully follow the treatment prescribed by your provider.
• Ask your provider if you should continue using your current eyedrops.
• After filtering surgery, your provider may want you to use an eye shield to protect your eye from injury.
• Follow your provider's instructions for patching the eye.
• Follow your provider's instructions for using eyedrops or ointment to prevent infection and reduce inflammation and scarring. Wash your hands with soap and water. Put drops or ointment in the eye by pulling down the lower lid and placing 1 to 2 drops or a short ribbon of ointment along the inside of the lower lid. Do not touch the tip of the applicator to your eye.
• If your eye develops any of the following signs of infection, tell your provider right away:
  • severe or worsening pain
  • worsening redness
  • increased swelling
  • loss of vision
  • a lot of eye drainage with pus
• Do not rub your eye unless your provider tells you to massage your eye.
• Avoid contact sports, strenuous work, swimming in pools or hot tubs, bending over past your knees, and lifting heavy objects for 2 weeks after the surgery.

Reviewed for medical accuracy by faculty at the Wilmer Eye Institute at Johns Hopkins. Web site: http://www.hopkinsmedicine.org/wilmer/

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