Glaucoma - Treating glaucoma

Treatment aims to reduce the pressure in the affected eye, called intraocular pressure.

Any damage to your vision caused by glaucoma can't be repaired so it's important to get an early diagnosis and treatment to prevent further damage.

Eye drops

Chronic open-angle glaucoma is often treated using eye drops. There are several different types of eye drops available, the type prescribed may depend on:

how your condition is progressing
whether you have other medical conditions
whether you are taking any other medications
whether the eye drops cause side effects when you use them

Using eye drops

It's important to use eye drops as directed. Even if you have not yet noticed any problems with your vision, without treatment glaucoma can cause permanent vision loss.

To use eye drops:

use your finger to gently pull down your lower eyelid
hold the bottle over your eye and allow a single drop to fall into the pocket you have created in your lower lid
close your eye and keep it closed for several minutes

If you are using two different types of eye drops, allow at least five to 10 minutes between using the different types.

Also follow any other advice your optometrist or ophthalmologist has given you.

Contact lenses

If you usually wear contact lenses and have been prescribed eye drops, you may need to stop wearing your lenses and wear glasses instead.

This is because medication in the eye drops can build up in the lenses and may harm your eyes. You should discuss this with healthcare professionals treating you.

Types of eye drops

The different types of eye drops are described below. You can read medicines information for more details about your medication.

Prostaglandin analogue

Prostaglandin analogues increase the flow of fluid (aqueous humour) out of your eye, which reduces the pressure within your eye (the intraocular pressure). These eye drops are usually used once a day.

Side effects include:

enlarged blood vessels in the white part of your eye, making your eye look red
changes to your eye colour – it often gets darker
eyelashes growing thicker and darker
eye pain and irritation
blepharitis – a condition where the rims of your eyelids become red and swollen
dry eyes
headaches
sensitivity to light

Some types of prostaglandin analogues that you may be prescribed include:

Beta-blockers

It is thought that beta-blockers reduce intraocular pressure by slowing down the production of aqueous humour in your eye. They are used once or twice a day and can cause side effects such as:

a stinging or burning sensation in your eye
dry eyes
itchy eyes

Beta-blockers can make some medical conditions worse, so do not use them if you have:

asthma
a heart condition, such as heart block

Some types of beta-blockers you may be prescribed include:

Carbonic anhydrase inhibitors

Carbonic anhydrase inhibitors reduce the amount of aqueous humour produced in your eye, which reduces intraocular pressure. These drops are used two or three times a day and may cause:

a bitter taste in your mouth
nausea (feeling sick)
a dry mouth
eye irritation

Some types of carbonic anhydrase inhibitors you may be prescribed include:

Sympathomimetics

Sympathomimetics are thought to reduce the rate of production of aqueous humour and increase the flow of aqueous humour out of the eyes. These eye drops are used twice a day and may cause your eyes to become painful and red.

Some types of sympathomimetics can only be used with caution in people who have:

A type of sympathomimetic that you may be prescribed is brimonidine tartrate.

Other treatments

If the use of eye drops does not improve your symptoms, a different type of treatment may be recommended, such as laser treatment or surgery. These are described in more detail below.

Laser treatment

Laser treatment, which uses high energy beams of light, can be used to open up the blocked trabecular meshwork (drainage tubes) within your eye. This is called laser trabeculoplasty.

Anaesthetic (painkilling) eye drops will be put into your eye and a special lens placed in front of your eye. The laser will be shone through the lens and will make small holes in the trabecular meshwork. This allows more fluid to drain out of your eye and reduces the intraocular pressure.

An alternative to laser trabeculoplasty is cyclodiode laser treatment. This involves destroying some of the tissue in the eye that produces aqueous humour. It creates less fluid in the eye, which reduces the intraocular pressure.

Laser treatments are usually quick and painless, although during the procedure you may feel a brief twinge of pain or heat. You may still need to use eye drops (see above) after having laser treatment.

Surgery

A trabeculectomy is the most common type of glaucoma surgery. It involves removing part of the trabecular meshwork to allow fluid to flow through the eye's drainage system.

The procedure will be carried out under local anaesthetic (you are awake) or general anaesthetic (you are unconscious).

Other types of surgery include:

a viscocanalostomy – this operation removes part of the sclera (the white outer covering of the eyeball), enabling the fluid to filter out of your eye and into your body
a deep sclerectomy operation – this operation involves implanting a tiny device inside your eye to widen the trabecular meshwork
an aqueous shunt implant – this operation involves placing a tube device into your eye to increase the drainage of fluid out of your eye

Speak to your surgeon to find out more about your procedure and risks involved.

If you are having surgery, your surgeon may choose to use anti-scarring medicines. These can improve the success of the operation by preventing scar tissue forming as your eye heals.

You may be prescribed either:

mitomycin C
5-fluorouracil

These medications are unlicensed for the treatment of glaucoma. This means that the manufacturers of these medications have not applied for a licence for their medication to be used to treat glaucoma.

But many specialists will use an unlicensed medication if they think the medication is likely to be effective and benefits of treatment outweigh associated risk. The National Institute for Health and Care Excellence (NICE) has issued guidance for the treatment of chronic open-angle glaucoma. It suggests these medicines can be used.

If your ophthalmologist is considering prescribing an unlicensed medication, they should inform you that it is unlicensed, and discuss possible risks and benefits with you.

Acute angle-closure glaucoma

As acute glaucoma develops rapidly, the condition needs to be treated quickly. The most common forms of treatment for this type of glaucoma include:

eye drops – see above for further details
systemic medicines – these are injected into your bloodstream to quickly reduce the pressure in your eye
laser treatment (called laser iridotomy) – this uses high-energy beams of light to create holes in your iris (coloured part of the eye) to open the angle and enable fluid to flow; both eyes may need to be treated, even if only one has acute angle-closure glaucoma, because this form of glaucoma may develop in both eyes at some point
surgery – a trabeculectomy (surgery to remove part of the drainage tubes) is the most common form of surgery for acute glaucoma

If you also have a cataract (a cloudy patch in the lens of your eye), removing it may open the angle in your eye and control the intraocular pressure.

Read about cataract surgery for more information about this procedure.

Miotics

Acute angle-closure glaucoma may also be treated with a medication called a miotic, such as pilocarpine.

Miotics work by opening up the blocked trabecular meshwork, which should improve the drainage of aqueous humour out of your eye. You may need to use these eye drops up to four times a day.

Miotics should be used with caution in people who have certain medical conditions, including:

Miotics can also cause side effects, such as:

a headache, which may be severe during the first two to four weeks of treatment
burning or itchy eyes
blurred vision, which may affect your ability to drive

Treating other types of glaucoma

For other types of glaucoma, your specialist will usually recommend eye drops, laser treatment or surgery. Your treatment will depend on the type of glaucoma you have and how advanced it is.

Monitoring your condition

If you have been diagnosed with glaucoma your condition will be closely monitored to check for further damage to your vision.

Depending on how your glaucoma is progressing, you may need further appointments every one to four months or up to 12-24 months apart. These will either be with:

an optometrist – a healthcare professional who examines eyes, tests vision and is trained to recognise eye diseases and vision defects
an ophthalmologist – a medical doctor who specialises in eye diseases and their treatment and surgery