Treatment for Glaucoma


Treatment for glaucoma depends on how severe it is and the nature of it.  Although glaucoma cannot be cured it can be controlled but visual loss, which has already occurred cannot be regained.  However, further visual loss, can be prevented.  Even if you do not have any clear symptoms, the disease can be progressing and causing eye damage without you realising.  Glaucoma treatment usually reduces intraocular pressure by improving aqueous flow through the eye or it reduces the production of aqueous. 

Medication

Vision can be preserved by reducing eye pressure by decreasing the amount of fluid in the eye, using topical eye drops.  The fluid is drained through a different pathway at the back of the eye.  There are many types of eye drops available but they often have many side effects, including:

  • Eye stinging
  • Red eyes
  • Blurred vision
  • Headaches
  • Difficulty breathing
  • Slowed pulse
  • Hair loss
  • Lower blood pressure
  • Impotence
  • Fatigue
  • Weakness
  • Depression
  • Memory loss
  • Dizziness
  • Itchy or swollen eyes
  • Dry mouth
  • Darkening of the iris
  • Changes in the pigment of the eyelid skin
  • Blurred vision from swelling of the retina
  • Allergic reactions
  • Frequent urination
  • Tingling sensation in the fingers and toes

Your ophthalmologist will suggest the most suitable eye drops for you and it may be a case of trial and error until you settle on a specific type, whilst weighing out the side effects.

Pills may be taken as an alternative or as well as eye drops and side effects of these include a tingling sensation of fingers and toes, as well as felling drowsy, a loss of appetite, irregular bowel movements, kidney stones, anaemia and bleeding, metallic taste in carbonated beverages, impotence and weight loss.

Laser Surgery for Glaucoma

If eye drops and pills are not working or are unsuitable, laser surgery may be recommended.  Laser surgery may be carried out on its own or in conjunction with eye drops.  There are a number of different types of laser surgery:

  • Trabeculoplasty - This is used to treat open angle glaucoma, and enables eye drainage so that eye pressure is reduced.  It is performed with an argon laser.  It is a painless procedure, which can delay or avoid operative trabeculectomy surgery.  However, there is often relapse from this type of surgery and pressure increases are expected within two years.
  • Selective Laser Trabeculoplasty (SLT) - This laser method allows eye drainage without damaging delicate eye tissue.
  • Iridotomy - This method of laser treatment involves making holes in the iris to allow fluid to flow as required.  If you have acute angle-closure, emergency treatment may be required including medication and an iridotomy.   
  • Cyclodiode Laser - This method of laser treatment is most suited to moderate to advanced forms of glaucoma and helps reduce eye pressure. 

Following laser surgery, eye pressure will require continuous monitoring until it has settled, some weeks later.

Operative Trabeculectomy Surgery

If medication and laser are unsuitable or have been ineffective, surgery may be carried out. 

The most effective method of treating glaucoma by reducing eye pressure long term is through operative surgery.  It is usually only suitable if you haven't had any previous eye surgery.  In this procedure, a miniature instrument is used to create a new drainage channel by removing a small piece of the trabecular meshwork so that the aqueous fluid can leave the eye instead of building up and raising eye pressure.  The new hole is covered by the conjunctiva.  There are risks involved in any surgical procedure and your ophthalmologist will weight out your risks with the risk of optic nerve damage if the eye is left untreated or if other treatments are used. 

The surgical procedure can be performed on an in-patient basis, or as a day-case where you can leave after surgery on the same day.  Either a local or general anaesthetic is administered.  Anti-scarring drugs are used to preserve the function of the new drainage channel for a longer period of time.  Following surgery, antibiotic and anti-inflammatory drops are taken to aid healing.  Although surgery may save remaining vision, eyesight may actually be worse after surgery.  Thus, early detection of glaucoma is very important.

Drainage Implant Surgery

Another type of operation is called drainage implant surgery, and involves inserting a small silicone tube into the eye to help drain aqueous humour.  Any eye patch is worn for 24 hours following surgery and eye drops are used to reduce the risk of infection and scarring.

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