Before surgery, you will receive numbing medication and anesthesia, and can often return home the same day (though you will require someone to drive you).

Some traditional surgeries can help to lower eye pressure. Meanwhile, modern techniques that may be less invasive and faster may even lower pressure more effectively than medication alone.

Trabeculectomy

After using both eye drops and laser surgery to lower eye pressure, if it remains too high your ophthalmologist may suggest an operation called trabeculectomy to create an alternate drainage path for fluid to leave your eye. Your surgeon creates this new pathway by making an incision on the white part of the sclera to create a drainage hole there and channel watery eye fluid away from glaucoma-causing areas into an area just under your surface skin (conjunctiva) where it forms into flattish structures called “blebs”.

This bleb is designed to absorb fluid and lower eye pressure. Studies show it to be successful about 60-80% of the time in doing this, leading patients to stop taking glaucoma eye drops afterward. Your ophthalmologist will monitor your eye pressure and perform additional tests to see whether your bleb is functioning effectively; should it stop functioning, an in-chair procedure will likely be performed to reactivate it and lower eye pressure again.

Trabecular Micro-Incisional Glaucoma Surgery (MIGS)

An endocyclophotocoagulation or ECP laser beam can be used to decrease eye’s fluid production activity, helping improve drainage system flow and decrease intraocular pressure. This treatment option is recommended for patients suffering from open-angle glaucoma.

Your front part of your eye contains a clear fluid known as aqueous humor, which nourishes and gives shape to the eyeball. Normally, this fluid drains out via an intricate drainage system; however, if this system becomes malfunctioning it could build up inside and cause vision loss.

Traditional surgeries like trabeculectomy and tube shunt surgery help lower eye pressure by improving the flow of eye fluid out. Unfortunately, these methods often come with early and late complications that prevent their use for some people with glaucoma. MIGS procedures offer less invasive alternatives that may provide some relief in terms of medication costs as well as reduced risks, making them an attractive option.

Cyclophotocoagulation

Your eye doctor will use surgery to create a new channel for fluid to escape your eye, such as creating a flap in the sclera and an air pocket (called a bleb). When the aqueous humor oozes from it through this flap and into its designated spot in the bleb, it can then be absorbed by surrounding tissue, thus lowering eye pressure.

Cyclophotocoagulation offers an alternative approach to surgical glaucoma treatments by decreasing fluid drainage through your eye, by targeting finger-like projections behind your iris called the ciliary processes and decreasing their production of aqueous fluid production.

Over time, various methods have been utilized to reduce glaucoma fluid production and increase drainage, such as medication, laser application or incisional surgeries. Cyclophotocoagulation provides a safe, non-invasive alternative for those who have not responded well to standard antiglaucoma drugs and/or failed trabeculectomy filtration procedures.

Iridotomy

An aqueous humor (clear nutrient fluid) circulates around the lens and pupil before draining through an angle between cornea and white part of eye (sclera). If this drainage route becomes obstructed, pressure in the eye increases rapidly causing acute angle-closure glaucoma which, left untreated, can result in permanent vision loss.

To avoid or treat this, your doctor can create a hole in the iris using laser, known as an Iridotomy or Laser Peripheral Iridotomy (LPI). This procedure opens up drainage angles in your eye while simultaneously lowering intraocular pressure and protecting against damage to optic nerve.

An iridectomy involves having the surgeon cut away part of the iris, with associated risks including bleeding and damage to internal structures in the eye. Laser technology provides a safer, faster method for making holes in iris. Studies have indicated this procedure reduces sudden attacks of angle-closure glaucoma in those with narrow angles or primary suspects who possess physically obstructive anterior chamber angles.