Medications are the most common early treatment for glaucoma. Standard practice has been to move on to surgery if medications are ineffective. However, recent studies support the use of surgery as a safe and effective initial treatment.
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Eyedrops
Glaucoma treatment often starts with medicated eyedrops. There are several types of drops the doctor may prescribe. It's important to use the drops exactly as prescribed to control your IOP. Skipping even a few doses can cause damage to the optic nerve to worsen. Some drops need to be applied several times each day, and others must be used just once a day. It's also important to inform your doctor of all medications you're currently taking, to avoid any undesirable drug interactions.
Because some of the eyedrops are absorbed into your bloodstream, you may experience side effects unrelated to your eyes. To minimize this absorption, close your eyes for 1 to 2 minutes after putting the drops in. Press lightly at the comer of your eye near your nose to close the tear duct, and wipe off any unused drops from your eyelid.
Oral medications
If eyedrops alone don't bring your eye pressure down to the desired level, your doctor may also prescribe oral medication. The most common oral medications for glaucoma are carbonic anhydrase inhibitors. These pills, which include acetazolamide (Diamox, Storzolamide, others), dichlorphenamide (Daranide) and methazolamide (Neptazane), should be taken with meals to reduce side effects. You can help to minimize the potassium loss that these medications can cause by adding bananas and apple juice to your diet.
When you first start taking these oral medications, you may experience a frequent need to urinate and a tingling sensation in the fingers and the toes. These symptoms often disappear after a few days. Other possible side effects of carbonic anhydrase inhibitors include rashes, depression, fatigue, lethargy, stomach upset, a metallic taste in carbonated beverages, impotence and weight loss. Kidney stones also can occur.
Surgery
Surgery might become necessary for the treatment of glaucoma if medications aren't effective or tolerated. Several different types of surgery are used, including laser surgery and more conventional procedures:
Laser surgery. In the last couple of decades, a procedure called trabeculoplasty (truh-BEK-yoo-loe-plas-tee) has been used increasingly in the treatment of open-angle glaucoma. The doctor uses a high energy laser beam to shrink part of the trabecular meshwork, which causes other parts of the meshwork to stretch and open up. This helps aqueous humor drain more easily from the eye.
This type of laser surgery is an office procedure that takes 10 to 20 minutes. You'll be given an anesthetic eyedrop, seated at a slit lamp and fitted with a special lens on your eye. The doctor aims the laser through the lens at the trabecular meshwork and applies bums to it. You will see bright flashes of light.
After the surgery you can immediately resume normal activities without discomfort. The doctor will check your eye pressure 1 to 2 hours after the procedure and several times in the following weeks. He or she may prescribe anti-inflammatory eyedrops for you to use for a few days following trabeculoplasty. It may take a few weeks before the full effect of the surgery becomes apparent.
In almost all cases, laser surgery for glaucoma initially lowers intraocular pressure. However, its effects may wear off over time. Studies show that eye pressure rises in many people 2 to 5 years after they receive the laser treatment.
Conventional surgery. If eyedrops and laser surgery aren't effective in controlling your eye pressure, you may need an operation called a trabeculectomy (truh-bek-yoo-LEK-tuh-mee). This procedure is done in a hospital or an outpatient surgery center. You'll receive medication to help you relax and eyedrops and an injection of anesthetic to numb your eye. Using delicate instruments under an operating microscope, the surgeon creates an opening in the sclera 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 there's not an open hole in your eye.
Your doctor will check your eye in several follow-up visits. You'll use antibiotic and anti-inflammatory eyedrops for some time after the operation to fight infection and scarring of the newly created drainage opening. Scarring is a particular problem for young adults, blacks and people who have had cataract surgery. This procedure works best if you haven't had any previous eye surgery.
Although glaucoma surgery may preserve current vision, it can't restore already lost vision. 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 trabeculectomy operation.
Drainage implants. Another type of operation, called drainage implant surgery, may be performed on people with secondary glaucoma or children with glaucoma.
Like the trabeculectomy, drainage implant surgery is performed at a hospital or an outpatient clinic. You'll be given medication to help you relax and eyedrops and anesthetic to numb the eye. Then the doctor inserts a small silicone tube in your eye to help drain aqueous humor.
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After the surgery you'll wear an eye patch for 24 hours and use eyedrops for several weeks to fight infection and scarring. Your doctor will check your eyes several times in the weeks that follow.
Complications from glaucoma surgery may include infection, bleeding, eye pressure that remains too high or too low and, potentially, loss of vision. Having eye surgery may also speed up the development of cataracts. Most of these complications can be effectively treated. To find out more, you can check out Vision Improvement Techniques.