Having Glaucoma surgery

Intro
In glaucoma, the pressure in your eye is too high, which damages the delicate optic nerve transmitting information from your eyes to your brain. High pressure can sometimes be treated with eye drops, but they have to be used for all your life and might not get the pressure low enough to be safe for your eye. In young people, it is usually better to do an operation and, if the operation is very successful, you might not need to use any drops!

What next?
Glaucoma operations lower the eye pressure, and your eye doctor (ophthalmologist) will talk to you about which operation is best for you. Children usually have a general anaesthetic, where you are asleep for the operation.

The operations are:

  • Goniotomy: the surgeon uses a tiny knife to open up the blocked drainage channel inside the eye. This only works in children who were born with glaucoma.
  • Trabeculotomy: the surgeon uses a fine wire to open the blocked drainage channel from outside the eye.
  • Trabeculectomy: the surgeon creates a completely new drainage channel from the inside of the eye to the surface using a tiny flap in the white of the eye. The fluid that escapes from inside the eye collects under this flap (bleb) and trickles back into the blood stream. Anti-scarring medicine is used on the eye during the operation to stop the new channel closing up.
  • Drainage tubes: the surgeon puts in place a tiny permanent plastic tube which allows the fluid to escape from inside the eye. This is a good option if there is a high risk of developing scar tissue. Sometimes, the surgeon uses removable stitches or gas or jelly inside the eye to adjust the pressure during the operation or afterwards.
  • Laser: the surgeon shines an invisible laser beam onto the area which makes the fluid inside the eye, so that less fluid is produced. This treatment might need to be repeated several times.

Before your surgery and on the day
See: General anaesthetic factsheet

After your surgery
The nurses will give you some eye drops to take home and use several times a day for a few weeks.  These treat inflammation (redness and soreness) and prevent infections.  If your eye(s) is/are painful after the operation, you can take painkillers which are suitable for young people, such as paracetamol or ibuprofen.

If you wear glasses, you will need to continue wearing them.  Your eye doctor will need to see you regularly at the clinic and measure the pressure in your eye.

Trouble spots
A child’s eyes are very delicate and, as with all surgery, there are possible side effects.  Most side effects are mild and recover, such as soreness, redness and bruising.  Listed below are some more serious possible complications.  As long as you are regularly checked by the eye clinic, it should be possible to identify any problem quickly.

  • Infection: If you ever get a red sticky eye with yellow discharge, you need to see an eye doctor as quickly as possible.  Infection inside the eye (called endophthalmitis) is very rare, but can cause severe damage.  This is treated with antibiotics.
  • Loose stitches: Stitches might become loose and cause your eye to become sore and red.  Loose stitches need removing.
  • Different eye appearance or feeling: Surgery can cause the shape of your pupil to look a bit different afterwards.  It might become oval or appear off-centre, but this will usually not affect your vision.  You might be able to see or feel the tiny bleb or tube underneath the top eyelid.
  • Very high or low pressure: The pressure in your eye might go very high or very low in the first few weeks after the operation and might need treatment with drops, medicine or more surgery.
  • Cataract: This is when the clear lens behind the pupil of your eye goes cloudy.  You might need glasses or an operation to improve your vision.

The result
Glaucoma operations are usually successful and the pressure goes down, although sometimes more than one operation is needed to achieve this.  Some children will continue to have poor vision afterwards or need lots of drops.

More stuff online
International Glaucoma Association:  glaucoma-asociation.com
Royal College of Ophthalmologists: rcophth.ac.uk
Royal National Institute of Blind People: RNIB.org.uk

 

Date Published: August 2011    Date for review: August 2013
Author: Moorfields Paediatric Information Group