Glaucoma is an eye disease that can damage the optic nerve. Normally, a clear fluid called aqueous humor flows into the eye and nourishes the tissues in the eye. It drains out of the eye through a special drainage system called the trabecular meshwork.

• Glaucoma is the buildup of the aqueous humor in the eye, usually due to problems with drainage. As the fluid builds up, the pressure inside the eye increases. This increased pressure can damage the optic nerve and lead to vision loss. Other eye structures can also be damaged.
• Once nerve cells are destroyed and vision is lost, the damage is permanent.

There are many different types of glaucoma. The four most common types are primary open-angle glaucoma (most common), angle-closure glaucoma (acute or chronic), secondary glaucoma (due to injury, inflammation, steroid use, or eye surgery), and congenital glaucoma (appears soon after birth).

A trabeculectomy is a type of surgical procedure that gives the fluid in the eye another way to drain. It involves making a small incision in the sclera (white part of the eye) and removing a piece of the trabecular meshwork. An opening may also be made in the iris (round structure that surrounds the pupil) so the fluid can drain out and form a small blister or “bleb.” The blood vessels in the eye then absorb the fluid or “bleb.”

• Prescription medications are used during surgery to prevent bleb failure, which can be caused by scarring that occurs as the wound heals.
• In certain cases, drainage implant surgery and placement of a special shunt may be recommended. With this surgery, a drainage device and tiny tube (shunt) are inserted into the eye to provide a passageway for excess fluid. As with a trabeculectomy, the fluid that drains out of the device is absorbed by the blood vessels in the eye.

What causes glaucoma to develop is unknown, but some risk factors include:

• high pressure in the eye
• a family history of glaucoma
• being African American, Latino, Hispanic or Asian American, especially if over 40
• diabetes or high blood pressure
• myopia (nearsightedness)
• being older than age 60
• use of certain medications called corticosteroids
• certain eye injuries
• pseudoexfoliation syndrome (the buildup of a protein-like substance in the eye that can interfere with the drainage of fluid.)

Glaucoma is diagnosed as part of an eye examination. Eye drops may be given to enlarge your pupils so that the structures within the eye can be seen more clearly. (Depending on the strength of the eye drops, you may experience blurry vision or light sensitivity for up to 24 hours.) The eye doctor will then use an instrument to look into your eye, measure your eye pressure, and examine the optic nerve. The eye doctor may also perform a test called a visual field examination and then may make treatment recommendations. Although there is no cure, various types of medications can help prevent vision loss associated with glaucoma. The medications work by reducing the pressure in the eye in one of two ways. The medications either improve the way the eye's drainage system works or by decreasing the amount of aqueous fluid produced inside the eye.

• If medication is not effective, laser surgery may help prevent damage to the optic nerve. There are different types of eye surgeries to treat glaucoma. These surgeries work in different ways by altering the trabecular meshwork to help fluid drain better, making an opening in the iris to let the aqueous fluid drain out, or by partially destroying the part of the eye that makes the aqueous fluid.

This care path includes the costs for creating a hole in the sclera and placing a drainage device to allow excess aqueous fluid to drain from the eye.

Surgery to treat glaucoma is typically done as an outpatient procedure in a hospital or ambulatory surgery center (ASC). Prior to the surgery, tell your healthcare provider about any medications you are taking (including over-the-counter medications and supplements). Ask about specific instructions you should follow before and after the surgery. These may include:

• medications you should not take before the procedure, such as blood thinners or aspirin
• regular medications you should continue to take on the day of your procedure
• how many hours you should stop eating and drinking before the procedure
• any activity restrictions you should follow during your recoveryIf you are a smoker, you should quit smoking, as it can interfere with your recovery.

During the surgery, you will most likely be awake. However, you will receive medication to keep you relaxed and eye drops to numb your eye. After surgery, anti-inflammatory eye drops, antibiotics, and other medications may be given. To protect the eye after the procedure, most people wear an eye patch for a few days. Your doctor will want you to avoid showering, swimming, driving, or strenuous exercise for a short time.

• You should make plans to have someone drive you home after the surgery.
• You may need to use several different eye drops before and after your surgery. Make sure you understand all the instructions given to you by the eye doctor.

What should I ask my healthcare provider before having glaucoma surgery?

• What is my diagnosis (type of glaucoma) and reason for the surgery? Do I have any permanent damage in my eye? What, if any, are the alternatives to surgery?
• Is there any special preparation for the surgery? (If so, get clear instructions on what you need to do.) What kind of sedation will I have? What are the possible side effects?
• What are the possible complications, how will I feel after the surgery, and how will I have to modify my activity?
• How many of these procedures have you performed? What kind of complications have your other patients experienced?

Make a list of your questions/concerns/symptoms and medications (including over-the-counter). After your surgery, you should know what you had done, what medication was given, and what symptoms you should report to your healthcare provider. You should also understand all home care instructions (including eye drops, medications, and side effects) and follow-up plans.

Source UHC.com

Also known as:

Lens Implant

Glaucoma - Eye Shunt

Eye Surgery

Eye Shunt

Eye Pressure