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Your health care provider will review your medical history and conduct a comprehensive eye examination. Your provider may perform several tests, including:

  • Measuring intraocular pressure, also called tonometry
  • Testing for optic nerve damage with a dilated eye examination and imaging tests
  • Checking for areas of vision loss, also known as a visual field test
  • Measuring corneal thickness with an exam called pachymetry
  • Inspecting the drainage angle, also known as gonioscopy

Treatment

The damage caused by glaucoma can’t be reversed. But treatment and regular checkups can help slow or prevent vision loss, especially if you catch the disease in its early stages.

Glaucoma is treated by lowering intraocular pressure. Treatment options include prescription eye drops, oral medicines, laser treatment, surgery or a combination of approaches.

Eyedrops

Glaucoma treatment often starts with prescription eye drops. Some may decrease eye pressure by improving how fluid drains from your eye. Others decrease the amount of fluid your eye makes. Depending on how low your eye pressure needs to be, you may be prescribed more than one eye drop.

Prescription eye drop medicines include:

  • Prostaglandins. These increase the outflow of the fluid in your eye, helping to reduce eye pressure. Medicines in this category include latanoprost (Xalatan), travoprost (Travatan Z), tafluprost (Zioptan), bimatoprost (Lumigan) and latanoprostene bunod (Vyzulta).Possible side effects include mild reddening and stinging of the eyes, darkening of the iris, darkening of the pigment of the eyelashes or eyelid skin, and blurred vision. This class of drug is prescribed for once-a-day use.
  • Beta blockers. These reduce the production of fluid in your eye, helping to lower eye pressure. Examples include timolol (Betimol, Istalol, Timoptic) and betaxolol (Betoptic S).Possible side effects include difficulty breathing, slowed heart rate, lower blood pressure, impotence and fatigue. This class of drug can be prescribed for once- or twice-daily use depending on your condition.
  • Alpha-adrenergic agonists. These reduce the production of the fluid that flows throughout the inside of your eye. They also increase the outflow of fluid in your eye. Examples include apraclonidine (Iopidine) and brimonidine (Alphagan P, Qoliana).Possible side effects include irregular heart rate, high blood pressure, fatigue, red, itchy or swollen eyes, and dry mouth. This class of drug is usually prescribed for twice-daily use but sometimes can be prescribed for use three times a day.
  • Carbonic anhydrase inhibitors. These medicines reduce the production of fluid in your eye. Examples include dorzolamide and brinzolamide (Azopt). Possible side effects include a metallic taste, frequent urination, and tingling in the fingers and toes. This class of drug is usually prescribed for twice-daily use but sometimes can be prescribed for use three times a day.
  • Rho kinase inhibitor. This medicine lowers eye pressure by suppressing the rho kinase enzymes responsible for fluid increase. It is available as netarsudil (Rhopressa) and is prescribed for once-a-day use. Possible side effects include eye redness and eye discomfort.
  • Miotic or cholinergic agents. These increase the outflow of fluid from your eye. An example is pilocarpine (Isopto Carpine). Side effects include headache, eye ache, smaller pupils, possible blurred or dim vision, and nearsightedness. This class of medicine is usually prescribed to be used up to four times a day. Because of potential side effects and the need for frequent daily use, these medicines are not prescribed very often anymore.

Because some of the eye drop medicine is absorbed into your bloodstream, you may experience some side effects unrelated to your eyes. To minimize this absorption, close your eyes for 1 to 2 minutes after putting the drops in. You also may press lightly at the corner of your eyes near your nose to close the tear duct for 1 or 2 minutes. Wipe off any unused drops from your eyelid.

You may have been prescribed multiple eye drops or need to use artificial tears. Make sure you wait at least five minutes in between using different drops.

Oral medications

Eye drops alone may not bring your eye pressure down to the desired level. So your eye doctor may also prescribe oral medicine. This medicine is usually a carbonic anhydrase inhibitor. Possible side effects include frequent urination, tingling in the fingers and toes, depression, stomach upset, and kidney stones.

Surgery and other therapies

Other treatment options include laser therapy and surgery. The following techniques may help to drain fluid within the eye and lower eye pressure:

  • Laser therapy. Laser trabeculoplasty (truh-BEK-u-low-plas-tee) is an option if you can’t tolerate eye drops. It also may be used if medicine hasn’t slowed the progression of your disease. Your eye doctor also may recommend laser surgery before using eye drops. It’s done in your eye doctor’s office. Your eye doctor uses a small laser to improve the drainage of the tissue located at the angle where the iris and cornea meet. It may take a few weeks before the full effect of this procedure becomes apparent.
  • Filtering surgery. This is a surgical procedure called a trabeculectomy (truh-bek-u-LEK-tuh-me). The eye surgeon creates an opening in the white of the eye, which also is known as the sclera. The surgery creates another space for fluid to leave the eye.
  • Drainage tubes. In this procedure, the eye surgeon inserts a small tube in your eye to drain excess fluid to lower eye pressure.
  • Minimally invasive glaucoma surgery (MIGS). Your eye doctor may suggest a MIGS procedure to lower your eye pressure. These procedures generally require less immediate postoperative care and have less risk than trabeculectomy or using a drainage device. They are often combined with cataract surgery. There are a number of MIGS techniques available, and your eye doctor will discuss which procedure may be right for you.

After your procedure, you’ll need to see your eye doctor for follow-up exams. And you may eventually need to undergo additional procedures if your eye pressure begins to rise or other changes occur in your eye.

Treating acute angle-closure glaucoma

Acute angle-closure glaucoma is a medical emergency. If you’re diagnosed with this condition, you’ll need urgent treatment to reduce the pressure in your eye. This generally will require treatment with medicine and laser or surgical procedures.

You may have a procedure called a laser peripheral iridotomy. The doctor creates a small hole in your iris using a laser. This allows fluid to flow through the iris. This helps to open the drainage angle of the eye and relieves eye pressure.