Glaucoma- When Do You Need Surgery?

Glaucoma usually has no obvious symptoms, you may not know you have the disease until a serious loss of vision occurs. Here’s how you can be watchful.

By Dr. N. Krishnan,  Consultant Ophthalmic Surgeon

World Glaucoma Day is observed on March 12th. Glaucoma usually has no obvious symptoms, you may not know you have the disease until a serious loss of vision occurs. In fact, half the people suffering from glaucoma do not realise they have the disease. An eye examination is the only way to tell if you have glaucoma. One should have a long talk with the eye specialist, to understand this rather silent disease.

What is Glaucoma? 

This is a situation where the pressure inside the eye increases (suddenly or gradually)over a period of time and damages the delicate nerves inside the eye resulting in Progressive or sudden loss of vision, resulting in total blindness if left untreated. There is an increase in pressure, damage to the optic nerve, corresponding damage to the brain, message to the brain is disturbed resulting in visual loss.

Types of Glaucoma:

  1. Chronic or Simple Glaucoma
  2. Acute or closed angle Glaucoma
  3. Low tension Glaucoma’
  4. Secondary Glaucoma
  5. Developmental Glaucoma
  6. Glaucoma Suspects


  1. Clinical examination- Gonioscopy
  2. Pressure check inside the eye
  3. Status of the optic nerve head
  4. Status of the retinal nerve fibres
  5. Checking of visual fields.
  6. Systemic examination.

Tips to use medication regularly:

  • Remember to use your medication regularly if it is part of your routine. Schedule it according to your convenience.
  • If you forget to use your eye drops administer a drop as soon as you remember, then get back to your schedule for the next drops.
  • Have the medicines at home,at the place where you work and also carry them while travelling.
  • Have always extra supply of drops with you.
  • Place the drops in a place so that it is always visible.
  • Learn to administer the drops yourself. Brace the eye drop on the bridge of your nose which may help delivering the drop regularly.
  • If you are using different types of drops, give an interval of 10 to 15 minutes in between two drops.
  • After administering a drop keep the eyes closed for a minute or two and gently press the tear duct near the inner corner of the eye. This helps in effective utilization of drugs in the eyes and as well prevent the medicine getting into the blood stream and affecting other parts of the body.
  • Tell your glaucoma specialist if your medications are too inconvenient, uncomfortable or expensive. He may suggest alternatives.
  • Take care of the other systems:
  • Some eye medicines affect other parts of the body.
  • Tell the other doctors you visit about your glaucoma and the medications you take.
  • Tell your eye doctor about other systemic problems you have so that he can choose appropriate anti-glaucoma medications that will suit you.
  • Avoid over-weight.
  • To reduce day to day stress have time for fun relaxation.

Surgery for Glaucoma:

It is called trabeculectomy creating a sump in the outer part of the eye where the fluid from within the eye drains out resulting in the reduction of the pressure inside the eye. All congenital glaucomas need surgery. Chronic stage of acute glaucoma ( closed-angle) and the certain situation in chronic open angle glaucoma indicate surgery.

When is surgery needed for Glaucoma? 

  1. When glaucoma is progressing in spite of medication.
  2. Surgery is done as a routine for cataracts, glaucoma is combined.
  3. Patients compliance is suspected.
  4. Patient can’t follow the drug schedule.
  5. Patient can’t afford medical treatment.

Remember, you can reduce complications by glaucoma if:

  1. You are diagnosed early
  2. You use medications regularly.
  3. Go for regular follow up once in three months
  4. Choose the right glaucoma specialist.
  5. Share your feelings with your family members and other glaucoma patients. (however, keep in mind that each case of glaucoma is slightly different.)
  6. There is nothing wrong in getting a second medical opinion if you feel you need some more clarification.
  7. Always you must overtake glaucoma by following medical advice and don’t let glaucoma overtake you.