Glaucoma : Treatment Options

Glaucoma treatments reduce pressure by improving aqueous outflow, reducing the production of aqueous, or both.

Glaucoma treatment often starts with medicated eyedrops. If eyedrops alone don't bring your eye pressure down to the desired level, your doctor may also prescribe an oral medication. Doctors commonly prescribe carbonic anhydrase inhibitors, such as acetazolamide (Diamox Sequels) and methazolamide (Neptazane), for glaucoma. Lowering the intraocular pressure provides only a partial solution when it comes to preserving vision in people with glaucoma. Ongoing clinical trials are evaluating certain drugs, such as brimonidine (Alphagan) and memantine (Namenda), to determine if they may help protect the optic nerve from damage associated with glaucoma.

You may need surgery to treat glaucoma if you can't tolerate medications or if they're ineffective. Sometimes a single surgical procedure may not lower eye pressure enough, in which case you'll need to continue using glaucoma drops or have another operation. In the last couple of decades, a procedure called trabeculoplasty has had an increased role in treating open-angle glaucoma. After giving you an anesthetic eyedrop, the doctor uses a high-energy laser beam to open clogged drainage canals and help aqueous humor drain more easily from the eye. This is an office procedure lasting 10 to 20 minutes, and you can usually resume normal activities without discomfort. The doctor will need to check your eye pressure several times in the following weeks.

If eyedrops and laser surgery aren't effective in controlling your eye pressure, you may need an operation called a filtering procedure, usually in the form of a trabeculectomy (truh-bek-u-LEK-tuh-me). This procedure is done in a hospital or an outpatient surgery center. You'll receive eyedrops, a medication to help you relax and usually an injection of anesthetic to numb your eye. Using delicate instruments under an operating microscope, your surgeon creates an opening in the sclera — the white of your eye — and removes a small piece of the trabecular meshwork. The aqueous humor can now freely leave the eye through this hole. As a result, your eye pressure will be lowered. The hole is covered by the conjunctiva, so trabeculectomy leaves no open hole in your eye. This procedure works best if you haven't had any previous eye surgery.

Another type of operation, called drainage implant surgery, may be an option for people with secondary glaucoma or for children with glaucoma. Drainage implant surgery takes place in a hospital or an outpatient clinic, and consists of a doctor inserting a small silicone tube in your eye to help drain aqueous humor.

Acute angle-closure glaucoma is a medical emergency. When you come in with this condition, doctors may administer several medications to reduce eye pressure as quickly as possible. You'll also likely have an iridotomy, a laser procedure that creates a small hole in your iris so that aqueous humor can pass into the trabecular meshwork.

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