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Treatments for Glaucoma

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Woman applying eye drops.

Treatments & Drugs

The most common treatments for glaucoma are eye drops and, rarely, pills. Doctors use a number of different categories of eye drops to treat glaucoma. They either decrease the amount of fluid (aqueous humor) in the eye or improve its outward flow, and some do both. Sometimes doctors will prescribe a combination of eye drops.

People using these medications should be aware of their purpose and potential side effects, which a medical professional should explain. Some side effects can be serious. If you are concerned, call your doctor immediately.

Doctor speaking with senior African American patient in clinic.

Glaucoma: Treatment Options

Your doctor should help you decide which medications are best suited for you based on your individual case of glaucoma, medical history, and current medication regimen. To help you prepare for a conversation with your doctor, we have created a downloadable guide.

See Available Treatments

Types of Medications

Medicine, laser treatment, and surgery are all effective for lowering intraocular pressure and preserving sight; however, not all treatments will work equally well for every individual. You and your doctor must decide on a treatment plan that takes into account your type of glaucoma, its severity, how quickly it’s progressing, and other factors.

  • This medication both reduces aqueous humor production and increases its outflow. Side effects include such things as blurry vision, fatigue, and increases in heart rate and blood pressure.

    Examples include: 

    • Apraclonidine (Iopidine®) 

    • Brimonidine (Alphagan®) 

    • Epinephrine (Gluacon® and Epifrin®)

    • Dipivefrin (Propine®)

  • This type of medication works to lower eye (intraocular) pressure by reducing aqueous humor production and decreasing the rate at which the fluid flows into the eye. Beta Blockers may cause side effects that include low blood pressure, reduced heart rate and shortness of breath.
     
    Examples include: 

    • Timolol (Timoptic XE®, Ocumeter® and Timoptic®) 

    • Levobunolol (Betagan®)

    • Carteolol (Ocupress®)

    • Metipranolol (OptiPranolol®)

    • Betaxolol (Betoptic®) 

  • Durysta™ is a new long-term, biodegradable eye implant, containing bimatoprost (prostaglandin analog) to reduce eye pressure in people with ocular hypertension or open-angle glaucoma. Durysta™ is currently indicated as a single-use implant, and patients who receive the implant would not be able to be re-administered a second time. 

    The most common side effect involving the eyes reported in patients using Durysta™ was eye redness. Other common side effects reported were: feeling like something is in your eye, eye pain, being sensitive to light, a blood spot on the white of your eye, dry eye, eye irritation, increased eye pressure, a loss of cells on the inner layer of the cornea, blurry vision, inflammation of the iris, and headache.

  • These are eye drops or pills that reduce fluid production in the eye. When administered as eyedrops, the side effects may include stinging, loss of appetite, and taste changes. When taken by mouth, they are associated with more unpleasant and or dangerous side effects, including depression, stomach problems, and weight loss, and there is an increased risk of serious anemia and kidney stones with long-term use.

    Examples include: 

    • Dorzolamide (Trusopt®) 

    • Brinzolamide (Azopt®) 

    • Acetazolamide (Diamox®): an oral medication 

    • Methazolamide (Neptazane®): an oral medication 

  • This type of medication is a cholinergic agent, which causes the pupil to become much smaller in diameter and helps increase fluid drainage from the eye. Side effects include eye irritation and allergy symptoms as well as an increased risk of near-sightedness and cataracts.  Side effects may include dermatitis, flu-like symptoms, urinary incontinence, lung congestion, and heart symptoms, including changes in heartbeat. 

    Examples include: 

    • Pilocarpine (Isopto Carpine®, Pilocar® and Pilopine HS® ointment)

    • Echothiophate (Phospholine Iodide®) 

  • This medication work as vasodilators, meaning they expand the blood vessels in your eye. It reduces eye pressure by increasing the outward flow of fluid from the eye. Side effects include eye sensitivity and irritation, as well as flu-like side effects which come and go. Sometimes these drugs cause eye color to darken or change, sunken eyes and eyelash growth.

    Examples include: 

    • Tafluprost ophthalmic solution (Zioptan™) 

    • Latanoprost (Xalatan®) 

    • Bimatoprost (Lumigan®) 

    • Travoprost (Travatan®) 

    • Unoprostone isopropyl ophthalmic solution (Rescula®) 

    • Latanoprostene bunod ophthalmic solution (Vyzulta™)

    • Latanoprost preservative-free formulation (Iyuzeh™)

  • This medication works by reducing the eye pressure by increasing the outward flow of fluid from the eye.- Side effects may include eye redness, stinging and corneal deposits.

    • Netarsudil ophthalmic solution (Rhopressa®)

  • Combinations of eye drops may also be used to achieve better results. Side effects of Cosopt include stinging or burning of the eye and taste change.  Side effects of Combigan include the symptoms of beta blockers and alpha agonists. Side effects of Simbrinza Suspension include blurred vision, eye irritation, taste change, dry mouth, and eye irritation. Side effects of Rocklatan include eye redness and stinging.

    Examples include: 

    • Dorzolamide and timolol (Cosopt®) 

    • Latanoprost and timolol (Xalacom®)

    • Brimonidine and timolol (Combigan™) 

    • Brinzolamide and brimonidine (Simbrinza®) 

    • Netarsudil and latanoprost (Rocklatan™) 

A medical illustration of a cross-section of an eye showing the light from a laser going to the top part of the iris.

Eye illustrations by Bob Morreale, provided courtesy of BrightFocus Foundation

Laser Therapies

Currently, laser surgery is the most frequently used procedure to treat glaucoma. It normally lowers eye pressure, but the length of time that pressure remains low depends on many factors, including: 

  • Age of the patient 

  • Type of glaucoma 

  • Other medical conditions that may be present 

Many cases still need continued medication but possibly in lower amounts.

A cross section of the eye showing the major anatomical parts.

 

Your doctor may use laser surgery to treat open-angle, angle-closure, or neovascular glaucoma. He or she will perform laser surgery on an outpatient basis in the office or clinic after numbing your eye. 

To reduce eye pressure, the doctor directs a laser toward the iris, ciliary body, retina, and trabecular meshwork (tissue near the cornea and iris that drains the aqueous humor from the eye into the blood)

Types of Laser Surgery

  • Trabeculoplasty
  • Laser Peripheral Iridotomy
  • Cyclophotocoagulation
  • Scatter Panretinal Photocoagulation

Trabeculoplasty

The most common laser procedure used for open-angle glaucoma, this procedure facilitates easier drainage. It can be performed several different ways.

In argon laser trabeculoplasty (ALT), a high-energy laser is aimed at the trabecular meshwork to open areas in these clogged canals. These openings allow fluid to bypass drainage canals and flow out of the eye. 

In selective laser trabeculoplasty (SLT) a low-energy laser treats specific cells in the trabecular meshwork. Because it affects only certain cells without causing collateral tissue damage, SLT can potentially be repeated. 

In micropulse laser trabeculoplasty (MLT) a low laser energy is delivered in short microbursts. It lowers pressure comparably to SLT and ALT, but there may be less inflammation and it could help to minimize the spikes in eye pressure that can sometimes occur after a laser procedure.

Learn More

Laser Peripheral Iridotomy

Laser peripheral iridotomy is frequently used to treat angle-closure glaucoma, in which the angle between the iris and the cornea is too small and blocks fluid flow out of the eye. A laser creates a small hole in the iris to allow fluid drainage.

Learn More

Cyclophotocoagulation

Cyclophotocoagulation is usually used to treat more aggressive or advanced open-angle glaucoma that has not responded to other therapies. Your doctor directs a laser through the sclera or endoscopically at the eye fluid-producing ciliary body. The procedure helps decrease the production of fluid and lower eye pressure. Patients often need multiple treatments.

Learn More

Scatter Panretinal Photocoagulation

This laser procedure destroys abnormal blood vessels in the retina that are associated with neovascular glaucoma. 

The most common side effects of laser surgery are: 

  • Temporary eye irritation and pain

  • Blurred vision 

  • Small risk of developing cataracts

 

Surgeons operating on a patient.

Surgery 

Eye doctors often use conventional surgical procedures (also called incisional therapies) for glaucoma after other treatment strategies, such as medications and laser surgery, have failed. 

When deciding on a treatment option, an ophthalmologist will take into account the unique aspects of each person's case, including the: 

  • The severity of the disease

  • Response to medication 

  • Other health issues 

 

Risks and benefits of glaucoma surgery
 
Types of Glaucoma Surgery
  • Conventional Surgery
  • Trabeculectomy 
  • Peripheral Iridectomy
  • Canaloplasty
  • Drainage Implant Devices

Conventional Surgery

Conventional surgery for glaucoma, sometimes called “filtering surgery,” lowers IOP by creating alternative pathways for aqueous humor to drain. In many of these procedures, the conjunctiva, or transparent membranes on the eye’s surface, are lifted and then replaced. They serve as a “filter,” or cover, over the eye’s new draining opening. That protects the eye and makes the increase in outflow much more gradual, which helps to stabilize eye pressure.

Trabeculectomy 

During a trabeculectomy, the ophthalmologist cuts a flap in the white part of the eye (sclera), removes a piece of trabecular meshwork (eye tissue located around the base of the cornea), and sutures the flap. This creates a new opening (a fluid bubble or bleb will form on the eye's exterior) through which the fluid (aqueous humor) flows and enters the bloodstream.

Potential short term-side-effects include blurred vision, bleeding in the eye and infection. Long-term effects may include worsened cataracts and the sensation of a foreign body in the eye. A buildup of fluid in the back of the eye may cause some shadows in vision. 

Trabectome®. This outpatient surgical procedure is used for open-angle glaucoma. After the eye is numbed, a small instrument creates a tiny incision in the cornea, which is the outer transparent structure at the front of the eye, and a piece of the trabecular meshwork is removed to increase fluid drainage. No permanent hole or bleb is left on the eye. Trabectome surgery normally does not have the side effects associated with a trabeculectomy, although some bleeding may occur during the procedure. 

 

Learn More

Peripheral Iridectomy

Eye doctors use this procedure for angle-closure glaucoma. The doctor removes a small section of peripheral iris by incision, which allows fluid to drain more easily from the eye. 

Canaloplasty

This procedure uses a small incision to gain access to Schlemm’s canal, the passageway into which aqueous humor flows from the trabecular meshwork. Then a microcatheter (a tiny flexible tube) is inserted to clear a channel though Schlemm’s canal. Sometimes a sterile, gel-like material is inserted to further expand the passageway. Canaloplasty is safe and effective alternative at achieving long-term IOP reductions with reduced risk of infection.

Drainage Implant Devices

Implants include tubes, shunts, and other devices that are placed in your eye to create a new drainage channel. Your doctor may suggest an implant when other forms of surgery haven’t been successful. 

Typically, an implant device features a thin tube or solid filament connected to a small plastic “plate.” In appearance, this looks like a large solid or flexible needle that has a shallow dish at its end. The plate is positioned on the outside of the eye (towards the back), under the conjunctiva, and the tube extends into the front chamber of the eye, where aqueous humor normally drains. The fluid drains through or along the tube or filament and collects around the plate at the back of the eye, where it is gradually absorbed by capillaries and the lymphatic system and transported out of the eye. 

Possible side effects include infection, failure of the tube shunts and other uncommon and rare complications such as bleeding inside the eye and double visions.

A baby lying in a crib and smiling.

Glaucoma Surgery for Infants

Goniotomy is used almost exclusively for infants with congenital glaucoma. In this procedure, the doctor makes a small opening in the trabecular meshwork. This procedure allows the eye fluid to flow normally out of the eye. 

Trabeculectomy is also used for infants with congenital glaucoma. The doctor makes an incision in the outer portion of the eye and uses a tiny probe to break through the trabecular meshwork. Eye fluid is then able to drain out of the eye, keeping eye pressure in a more normal range. 

Combined Glaucoma and Cataract Surgery 

Both cataracts and glaucoma are vision problems of aging, and an estimated one-fifth of all cataract removal procedures in the U.S. are performed on individuals who also have glaucoma or elevated IOP. Now there are several ways to accomplish both corrective surgeries in one operation. The decision of performing a combined approach and the type of glaucoma surgery, will depend on various factors including the type of glaucoma and its severity.  Talk to your doctor if this option interests you. 

Preparing for Surgery and Recovery  

Your doctor has the responsibility to evaluate and document your need for surgery, explain its risks and benefits, and obtain informed consent—which shows you understand and give your permission. She should review all your current medications and rule out allergies to any anesthesia and/or antibiotics that may be used.  

Ask for detailed written instructions about where your surgery will take place and “dos and don’ts” in the days before and following the procedure. You won’t be able to drive home, so someone needs to accompany you or pick you up from the hospital or surgical center. 

In the days following the procedure, your eye will be sore and bruised, and your vision may be blurry. That should clear up within a couple of weeks.  Written discharge instructions should alert you to signs of infection, or other dangers. They should also give the time and place of your follow-up appointment. 

Other Things You Should Know 

While there’s still no cure for open-angle glaucoma, there are many ways to minimize the damage caused by this disease. Advanced technologies are making it possible to detect glaucoma early enough to avert vision loss for decades and even an entire lifetime. Vision scientists continue to look for new treatments that may be more efficient and convenient.

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