Management

Management and treatment of glaucoma needs long term follow-up.

The treatment is usually for lifetime.

Drugs -

They can be -

	Eyedrops,
	Tablets,
	Rarely intravenous solutions- used only in emergency.

These decrease the eye pressure, by

	Increasing the outflow of aqueous
	Decreasing aqueous production

Betablockers - Most popular. e.g. Timolol, Betoxolol

Aqueous suppressants- e.g. Diamox tablets, Trusopt

Others- Pilocarpine, Latanoprost, Alfagan, Betagan etc. (no proprietary interests any drugs)

These drugs have side-effects and their information must be sought.

To decrease the side effects of the eyedrops

	Use only one drop of medication at a time.
	Close eyelid after instillation.
	Close the lacrimal punctum, by pressure on inner side of the lid (not the eye). This prevents the drops from getting absorbed into the blood stream.

Surgery

Laser -

Laser treatment is helpful in some cases.

	In the angle in open angle glaucoma, called as *Laser Trabeculoplasty*.
	On the iris, to make a connecting opening ,in Angle closure glaucoma. This is called as *Laser Iridotomy*.

Trabeculectomy

In this a scleral flap is made and a small part of the trabecular meshwork is excised.

After surgery, a small translucent elevation is seen is the area of surgery, called, 'bleb'. This indicates that the procedure is working. After surgery, drops may be required in addition. Sometimes, there may be scarring, and a repeat surgery may have to be done.

Sometimes, to avoid scarring, Mitomycin or such kind of medicine may be used during surgery or later, to prevent scarring.

If even after repeated surgeries, the pressure is uncontrolled, then a Seton is placed surgically. This acts as a pipe to drain aqueous outside.

Management of Glaucoma

Drugs -

To decrease the side effects of the eyedrops

Surgery

Laser -

Trabeculectomy