Understanding glaucoma

Glaucoma is a common eye condition where the nerve connecting the eye to the brain is damaged as a result of increased pressure in the eye. It can usually be treated with medication in the form of eyedrops, but should this not resolve the issue sufficiently, surgery may be required in order to lower the pressure in the eye before further damage to the eye is caused.

What is glaucoma?

Glaucoma is the medical term used to describe a group of conditions affecting the eye where damage is caused to the optic nerve. 

The optic nerve transmits electrical signals from the retina to the brain for visual processing. Your eye needs a certain amount of pressure inside it in order to maintain its shape. If the pressure inside the eye becomes too high and is left untreated, damage to the optic nerve can occur. This can lead to loss of vision.

Any sight lost due to glaucoma cannot be restored, but with the correct treatment and ongoing monitoring, further sight loss can usually be prevented. Early diagnosis and treatment are important, as glaucoma is one of the primary causes of blindness in the world.

Most types of glaucoma have no symptoms, especially in the early stages, so regular eye checks are important in order to detect the condition as early as possible.

The aim of any treatment for glaucoma is to lower the pressure in the eye to a healthier level. Depending on the extent and severity of any damage and/or sight loss caused by glaucoma, treatment may involve medication, laser treatment or surgery.

Medication: Eye drops are the most common way of managing glaucoma. Simple to use and effective in many cases, these are used a number of times a day. You will need to continue using these long-term, unless advised by your doctor to stop and it is important to continue using any eye drops you are prescribed, even if you cannot feel any difference in your eyes.  

Laser treatment: A laser is a high-energy beam of light. Shining a laser onto specific parts of your eye can help stop fluid (and hence pressure) building up. There are a number of different laser treatment available, and your consultant at St Joseph’s will be able to talk to you further about these.

Surgery: Where medication or laser treatment do not lower the pressure in the eye sufficiently, surgery may be required to help prevent further loss of vision. There are four common types of operation carried out:

  • Trabeculectomy: this is the most common operation carried out for glaucoma. The surgery involves removing part of the tubes that drain the eye, allowing excess fluid to drain more easily. 
  • Trabeculotomy: similar to a trabeculectomy, although this involves using an electrical current to remove a small part of the drainage tubes in the eye.
  • Viscocanalostomy: removal of a small section of the sclera (the white outer covering of the eyeball) to improve the drainage of fluid from the eye.
  • Trabecular stent bypass: placement of a small tube (stent) in the eye to allow fluid to drain through it.

Surgery to treat glaucoma is often carried out under local anaesthetic, meaning you are awake but the area around your eye is numb so that you don’t feel any pain. In some cases, the surgery is done under general anaesthetic, but this will be decided in advance by your consultant and the anaesthetist, after consultation with you.  

You may be given some medication, in the form of eyedrops or ointment, to promote healing and prevent infection and it is important you follow the instructions you are given about using these. You will not normally need a follow-up appointment, but should you have any queries or concerns at any stage after your surgery, you should contact our ophthalmology team for advice.   

Any eye drop medication carries the potential for side-effects or adverse reactions, including:

  • Irritation to the eye and surrounding areas,
  • Worsening of symptoms for another eye condition,
  • Allergic reaction to the medication.

 Laser treatment can cause blurry vision for a couple of hours after the procedure and the pressure in your eye may rise immediately afterwards. You may also have inflammation.

Any surgical procedure carries risks and the potential for complications, including:

  • Infection,
  • Pain,
  • Reaction to the anaesthetic,
  • Formation of blood clots.

 Complications and risks specific to surgery for glaucoma include:

  • Discomfort in the eye,
  • Bruising of the eyelid,
  • Scarring on or around the eyelid,
  • Difficulty in fully closing the eye.

The above risks are intended as guidelines only and are not exhaustive. We always recommend that you talk with your consultant about potential risks and complications before you decide to have any surgery. 

Should you be concerned about glaucoma and would like your eye health to be checked by a specialist, please get in touch with our ophthalmology team to arrange an appointment.

The consultant-led ophthalmology team at St Joseph’s Hospital is at the forefront of ophthalmic care in the UK and can help with the diagnosis, treatment and monitoring of glaucoma.

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