Do I Need Surgery for My Glaucoma?

Medically Reviewed by Whitney Seltman, OD on June 20, 2022
5 min read

Surgery isn’t usually the first step to treat glaucoma, but it may save your eyesight if other treatments don’t work.

Glaucoma is a condition in which there is optic nerve damage or the threat of damage from (usually increased)  pressure inside your eye, The eye, like a basketball, can become overinflated. Fluid in your eye can’t drain out the way it should. This can damage the optic nerve inside your eye and harm your vision.

Your eye doctor will give you prescription eye drops or rarely oral medicine to lower the pressure in your eye. If drugs don’t work, surgery is the next step.

If the medicine causes severe side effects like high blood pressure, rapid heartbeat, or impotence, you may want to try surgery instead. Some people need it right away if their eye pressure is high and puts their vision at risk.

Doctors may try laser surgery first. You can get the treatments in your doctor’s office or at a clinic. You’ll be able to go home after the procedure and get back to your normal routine by the next day.

The laser is a beam of very focused light. It’s aimed at your eye to help open clogged tubes and drain fluid. It can take a few weeks to see the full results.

Here are some types of laser surgery for glaucoma:

Argon laser trabeculoplasty (ALT): This opens clogs in your eye so fluid can drain out. Your doctor may treat half of the clogs first, see how well it works, then treat the other half later. ALT works in about 75% of people with the most common kind of glaucoma.

Selective laser trabeculoplasty (SLT): If ALT doesn’t work so well, your doctor may try this. Your doctor beams a highly targeted low-level laser at just the spots where there’s pressure. You can do SLT a little at a time. Oftentimes this may be the first surgical step because it is more specific.

Laser peripheral iridotomy (LPI): If the space between your eye’s iris (the colored part) and cornea (the clear outer layer) is too small, you can get narrow-angle glaucoma. Fluid and pressure build up in this area. LPI uses a laser beam to create a tiny hole in the iris. The extra fluid can drain and relieve pressure.

Cyclophotocoagulation: If other laser treatments or surgery doesn't ease fluid buildup and pressure, your doctor can try this. They’ll beam a laser into a structure inside your eye to ease pressure. You may need to repeat it over time to keep your glaucoma in check.

You can usually have laser surgery in your doctor’s office or an outpatient eye clinic. The doctor will numb your eyes. You shouldn’t feel much or even any pain during the treatment. You might notice a slight sting or burn.

While you lie still, your doctor will hold a special lens up to your eye, then aim the laser at the exact spot where you need treatment. It may look like a very quick, bright flash.

Your eyesight may be a little blurry right after the treatment. It may feel a little sore, too. In a couple of hours, the doctor will check your eye pressure. You’ll need someone to drive you home after the surgery.

You may need to stay on your medications after laser surgery to keep your eye pressure under control.

If laser surgery or drugs don’t relieve your eye pressure, you may need a more traditional operation. You might have to go into the hospital or surgery center, and you’ll probably need a few weeks to heal and recover.

These procedures include:

Trabeculectomy: The surgeon will make a small cut in the white part of your eye to take out some of the mesh of tissue inside. This helps the extra fluid drain out. You may need to take some medicine along with this surgery so scar tissue doesn’t form. The procedure “is performed as outpatient surgery.

Drainage implant surgery: The doctor places a tiny tube inside your eye so fluid can drain. Now there are minimally invasive implants.

Electrocautery: In this procedure, the surgeon uses a heat device called a Trabectome to make a tiny cut in your eye’s drainage tubes. It sends heat to the mesh of tissue inside your eye. It can ease fluid buildup and pressure. It’s not as invasive as trabeculectomy or drainage implant surgery.

Minimally invasive glaucoma surgeries (MIGS). This is a newer set of treatments. They usually require tiny openings and use devices you can’t see with the naked eye. They’re generally faster and safer, but won’t lower pressure by quite as much. They can also be done at the same time as other procedures like cataract surgery.

You’ll get drugs to numb your eye and relax you. You shouldn’t feel any pain. You may feel really drowsy during the operation.

After surgery, you’ll rest at home for about a week. You doctor may have special instructions or precautions. Keep water out of your eye. Your eye may be red, sore, or watery. You may also see a little bump where the cut was made.

Your vision might be a little blurry for about 6 weeks. Contact lenses may not fit until the bump or swelling goes down. About half of people who get this surgery no longer need medications to keep pressure down.

Glaucoma surgery can make you more likely to get cataracts later. Other possible risks include:

  • Eye pain or redness
  • Eye pressure that’s still too high or even too low
  • Loss of vision
  • Infection
  • Inflammation
  • Bleeding in your eye

Glaucoma surgery can’t restore eyesight you’ve lost already. You may need to take drugs or have more surgery down the road if pressure builds up again. Get regular eye exams to make sure you’re OK.