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What is glaucoma? Glaucoma is a group of diseases that can damage the eye's optic nerve and result in vision loss and blindness. Glaucoma occurs when the normal fluid pressure inside the eyes slowly rises. However, with early treatment, you can often protect your eyes against serious vision loss. While glaucoma can strike anyone, the risk is much greater for people over 60. There are several different types of glaucoma. Most of these involve the drainage system within the eye. At the front of the eye there is a small space called the anterior chamber. A clear fluid flows through this chamber and bathes and nourishes the nearby tissues. In glaucoma, for still unknown reasons, the fluid drains too slowly out of the eye. As the fluid builds up, the pressure inside the eye rises. Unless this pressure is controlled, it may cause damage to the optic nerve and other parts of the eye and result in loss of vision. Glaucoma can develop in one or both eyes. What is the optic nerve? The optic nerve is a bundle of more than 1 million nerve fibers. It connects the retina to the brain. The retina is the light-sensitive tissue at the back of the eye. A healthy optic nerve is necessary for good vision. What are some other forms of glaucoma? Open-angle glaucoma is the most common form. Some people have other types of the disease. Low-tension or normal-tension glaucoma Optic nerve damage and narrowed side vision occur in people with normal eye pressure. Lowering eye pressure at least 30 percent through medicines slows the disease in some people. Glaucoma may worsen in others despite low pressures. A comprehensive medical history is important in identifying other potential risk factors, such as low blood pressure, that contribute to low-tension glaucoma. If no risk factors are identified, the treatment options for low-tension glaucoma are the same as for open-angle glaucoma. Angle-closure glaucoma The fluid at the front of the eye cannot reach the angle and leave the eye. The angle gets blocked by part of the iris. People with this type of glaucoma have a sudden increase in eye pressure. Symptoms include severe pain and nausea, as well as redness of the eye and blurred vision. If you have these symptoms, you need to seek treatment immediately. This is a medical emergency. If your doctor is unavailable, go to the nearest hospital or clinic. Without treatment to improve the flow of fluid, the eye can become blind in as few as one or two days. Usually, prompt laser surgery and medicines can clear the blockage and protect sight. Congenital glaucoma Children are born with a defect in the angle of the eye that slows the normal drainage of fluid. These children usually have obvious symptoms, such as cloudy eyes, sensitivity to light, and excessive tearing. Conventional surgery typically is the suggested treatment, because medicines may have unknown effects in infants and be difficult to administer. Surgery is safe and effective. If surgery is done promptly, these children usually have an excellent chance of having good vision. Secondary glaucomas These can develop as complications of other medical conditions. These types of glaucomas are sometimes associated with eye surgery or advanced cataracts, eye injuries, certain eye tumors, or uveitis (eye inflammation). Pigmentary glaucoma occurs when pigment from the iris flakes off and blocks the meshwork, slowing fluid drainage. A severe form, called neovascular glaucoma, is linked to diabetes. Corticosteroid drugs used to treat eye inflammations and other diseases can trigger glaucoma in some people. Treatment includes medicines, laser surgery, or conventional surgery. How does open-angle glaucoma damage the optic nerve? In the front of the eye is a space called the anterior chamber. A clear fluid flows continuously in and out of the chamber and nourishes nearby tissues. The fluid leaves the chamber at the open angle where the cornea and iris meet. (See diagram below.) When the fluid reaches the angle, it flows through a spongy meshwork, like a drain, and leaves the eye. Sometimes, when the fluid reaches the angle, it passes too slowly through the meshwork drain. As the fluid builds up, the pressure inside the eye rises to a level that may damage the optic nerve. When the optic nerve is damaged from increased pressure, open-angle glaucoma--and vision loss--may result. That's why controlling pressure inside the eye is important. Does increased eye pressure mean that I have glaucoma? Not necessarily. Increased eye pressure means you are at risk for glaucoma, but does not mean you have the disease. A person has glaucoma only if the optic nerve is damaged. If you have increased eye pressure but no damage to the optic nerve, you do not have glaucoma. However, you are at risk. Follow the advice of your eye care professional. Can I develop glaucoma if I have increased eye pressure? Not necessarily. Not every person with increased eye pressure will develop glaucoma. Some people can tolerate higher eye pressure better than others. Also, a certain level of eye pressure may be high for one person but normal for another. Whether you develop glaucoma depends on the level of pressure your optic nerve can tolerate without being damaged. This level is different for each person. That's why a comprehensive dilated eye exam is very important. It can help your eye care professional determine what level of eye pressure is normal for you. Can I develop glaucoma without an increase in my eye pressure? Yes. Glaucoma can develop without increased eye pressure. This form of glaucoma is called low-tension or normal-tension glaucoma. It is not as common as open-angle glaucoma. Who is at risk for glaucoma? Anyone can develop glaucoma. Some people are at higher risk than others. They include: - African Americans over age 40. - Everyone over age 60, especially Mexican Americans. - People with a family history of glaucoma. Among African Americans, studies show that glaucoma is: - Five times more likely to occur in African Americans than in Caucasians. - About four times more likely to cause blindness in African Americans than in Caucasians. - Fifteen times more likely to cause blindness in African Americans between the ages of 45-64 than in Caucasians of the same age group. A comprehensive dilated eye exam can reveal more risk factors, such as high eye pressure, thinness of the cornea, and abnormal optic nerve anatomy. In some people with certain combinations of these high-risk factors, medicines in the form of eyedrops reduce the risk of developing glaucoma by about half. Medicare covers an annual comprehensive dilated eye exam for some people at high risk for glaucoma. What can I do to protect my vision? Studies have shown that the early detection and treatment of glaucoma, before it causes major vision loss, is the best way to control the disease. So, if you fall into one of the high-risk groups for the disease, make sure to have your eyes examined through dilated pupils every two years by an eye care professional. If you are being treated for glaucoma, be sure to take your glaucoma medicine every day. See your eye care professional regularly. You also can help protect the vision of family members and friends who may be at high risk for glaucoma--African Americans over age 40; everyone over age 60, especially Mexican Americans; and people with a family history of the disease. Encourage them to have a comprehensive dilated eye exam at least once every two years. Remember: Lowering eye pressure in glaucoma's early stages slows progression of the disease and helps save vision. What are the symptoms of glaucoma? At first, there are no symptoms. Vision stays normal, and there is no pain. However, as the disease progresses, a person with glaucoma may notice his or her side vision gradually failing. That is, objects in front may still be seen clearly, but objects to the side may be missed. As glaucoma remains untreated, people may miss objects to the side and out of the corner of their eye. Without treatment, people with glaucoma will slowly lose their peripheral (side) vision. They seem to be looking through a tunnel. Over time, straight-ahead vision may decrease until no vision remains. Glaucoma can develop in one or both eyes. How is glaucoma detected? Glaucoma is detected through a comprehensive eye exam that includes: Visual acuity test This eye chart test measures how well you see at various distances. A tonometer measures pressure inside the eye to detect glaucoma. Visual field test This test measures your side (peripheral) vision. It helps your eye care professional tell if you have lost side vision, a sign of glaucoma. Dilated eye exam Drops are placed in your eyes to widen, or dilate, the pupils. Your eye care professional uses a special magnifying lens to examine your retina and optic nerve for signs of damage and other eye problems. After the exam, your close-up vision may remain blurred for several hours. Tonometry An instrument (right) measures the pressure inside the eye. Numbing drops may be applied to your eye for this test. Pachymetry A numbing drop is applied to your eye. Your eye care professional uses an ultrasonic wave instrument to measure the thickness of your cornea. Can glaucoma be treated? Yes. Immediate treatment for early stage, open-angle glaucoma can delay progression of the disease. That's why early diagnosis is very important. Glaucoma treatments include medicines, laser trabeculoplasty, conventional surgery, or a combination of any of these. While these treatments may save remaining vision, they do not improve sight already lost from glaucoma. Medicines Medicines, in the form of eyedrops or pills, are the most common early treatment for glaucoma. Some medicines cause the eye to make less fluid. Others lower pressure by helping fluid drain from the eye. Before you begin glaucoma treatment, tell your eye care professional about other medicines you may be taking. Sometimes the drops can interfere with the way other medicines work. Glaucoma medicines may be taken several times a day. Most people have no problems. However, some medicines can cause headaches or other side effects. For example, drops may cause stinging, burning, and redness in the eyes. Many drugs are available to treat glaucoma. If you have problems with one medicine, tell your eye care professional. Treatment with a different dose or a new drug may be possible. Because glaucoma often has no symptoms, people may be tempted to stop taking, or may forget to take, their medicine. You need to use the drops or pills as long as they help control your eye pressure. Regular use is very important. Make sure your eye care professional shows you how to put the drops into your eye. Laser trabeculoplasty Laser trabeculoplasty helps fluid drain out of the eye. Your doctor may suggest this step at any time. In many cases, you need to keep taking glaucoma drugs after this procedure. Laser trabeculoplasty is performed in your doctor's office or eye clinic. Before the surgery, numbing drops will be applied to your eye. As you sit facing the laser machine, your doctor will hold a special lens to your eye. A high-intensity beam of light is aimed at the lens and reflected onto the meshwork inside your eye. You may see flashes of bright green or red light. The laser makes several evenly spaced burns that stretch the drainage holes in the meshwork. This allows the fluid to drain better. Like any surgery, laser surgery can cause side effects, such as inflammation. Your doctor may give you some drops to take home for any soreness or inflammation inside the eye. You need to make several follow-up visits to have your eye pressure monitored. If you have glaucoma in both eyes, only one eye will be treated at a time. Laser treatments for each eye will be scheduled several days to several weeks apart. Studies show that laser surgery is very good at reducing the pressure in some patients. However, its effects can wear off over time. Your doctor may suggest further treatment. Conventional surgery Conventional surgery makes a new opening for the fluid to leave the eye. (See diagram.) Your doctor may suggest this treatment at any time. Conventional surgery often is done after medicines and laser surgery have failed to control pressure. Conventional surgery is performed in an eye clinic or hospital. Before the surgery, you will be given medicine to help you relax. Your doctor will make small injections around the eye to numb it. A small piece of tissue is removed to create a new channel for the fluid to drain from the eye. For several weeks after the surgery, you must put drops in the eye to fight infection and inflammation. These drops will be different from those you may have been using before surgery. As with laser surgery, conventional surgery is performed on one eye at a time. Usually the operations are four to six weeks apart. Conventional surgery is about 60 to 80 percent effective at lowering eye pressure. If the new drainage opening narrows, a second operation may be needed. Conventional surgery works best if you have not had previous eye surgery, such as a cataract operation. In some instances, your vision may not be as good as it was before conventional surgery. Conventional surgery can cause side effects, including cataract, problems with the cornea, and inflammation or infection inside the eye. The buildup of fluid in the back of the eye may cause some patients to see shadows in their vision. If you have any of these problems, tell your doctor so a treatment plan can be developed. Conventional surgery makes a new opening for the fluid to leave the eye. How should I use my glaucoma eyedrops? If eyedrops have been prescribed for treating your glaucoma, you need to use them properly and as instructed by your eye care professional. Proper use of your glaucoma medication can improve the medicine's effectiveness and reduce your risk of side effects. To properly apply your eyedrops, follow these steps: - First, wash your hands. - Hold the bottle upside down. - Tilt your head back. - Hold the bottle in one hand and place it as close as possible to the eye. - With the other hand, pull down your lower eyelid. This forms a pocket. - Place the prescribed number of drops into the lower eyelid pocket. If you are using more than one eyedrop, be sure to wait at least five minutes before applying the second eyedrop. - Close your eye OR press the lower lid lightly with your finger for at least one minute. Either of these steps keeps the drops in the eye and helps prevent the drops from draining into the tear duct, which can increase your risk of side effects What can I do if I already have lost some vision from glaucoma? If you have lost some sight from glaucoma, ask your eye care professional about low vision services and devices that may help you make the most of your remaining vision. Ask for a referral to a specialist in low vision. Many community organizations and agencies offer information about low vision counseling, training, and other special services for people with visual impairments. A nearby school of medicine or optometry may provide low vision services.
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ili zelena mrena je bolest karakterizirana povremenim ili trajnim povišenjem očnog tlaka, oštečenjem vidnog živca i propadanjem vidnog polja, a kao posljedica bolesti može nastupiti i sljepoća. Podijela glaukoma : Definicija Glaukom (od grč. glaukos = zelen, zbog sivo-zelenog odsjaja leće u zahvaćenom oku) je naziv za grupu bolesti koja vodi ka oštećenju vidnog živca te je vodeći uzrok sljepoće kod ljudi iznad 40 godina. Glaukom nije bolest već sindrom, odnosno skup slijedećih simptoma: Dugotrajno povišen očni tlak dovodi do druga dva simptoma. Etiologija Glaukom se razvija kad je stvaranje očne vodice povećano ili je njeno otjecanje otežano. Tada dolazi do porasta očnog pritiska, do pritiska na živčana vlakna i krvne žile optičkog živca i do njihovog oštećenja i uništenja. Postupno se prekida prijenos vizualne poruke do mozga, a rezultat je oštećenje vida i na kraju sljepoća. Glaukom je bolest koja se ne može izliječiti, ali zahvaljujući ranom otkrivanju bolesti i odgovarajućem liječenju može se spriječiti trajni gubitak vida i kontrolirati tok bolesti. Očna vodica Očna vodica hrani strukture prednjeg dijela oka i daje tonus očnoj jabučici. Vodica se stvara u nastavcima zrakastog tijela oka. Cirkulira kroz stražnju sobicu, zatim prolazi kroz zjenični otvor i ulazi u prednju sobicu, odakle preko trabekularnog sustava u sobnom kutu ulazi u kanal iz kojeg se prenosi u venski sustav. Na taj se način odstranjuje iz oka. Normalne vrijednosti očnog tlaka Normalni očni tlak iznosi 12 – 22 mmHg (milimetara žive). Vrste glaukoma Glaukomi se dijele u tri osnovne velike skupine: Kod primarnog glaukoma postoji povećanje očnog tlaka koje se ne može dovesti ni u kakvu vezu s nekom očnom ili općom bolesti. Prema izgledu kuta prednje očne sobice (prostor u oku između rožnice i šarenice) primarni glaukom se dijeli na: Sekundarni glaukom je povišenje očnog tlaka koje nastaje u tijeku neke druge očne bolesti (stanja) ili je posljedica te bolesti (kao npr. upale, ozljede, oštećenja i pomaci leće u oku, krvnožilne bolesti oka, šećerna bolest, tumori oka). Prirođeni glaukom nastaje jer u kutu prednje očne sobice postoji tkivo koje normalno nestaje prije rođenja. Očna vodica ne može otjecati i nastaje povišenje očnog tlaka. Kod ovog tipa glaukoma se iz nepoznatog razloga s godinama povećava otpor otjecanju očne vodice i očni tlak konstantno raste. Porast očnog tlaka je umjeren u početku, a kasnije može doseći visoke vrijednosti (60 mmHg). S vremenom stradava očni živac i udubljuje se papila vidnog živca (mjesto na kojem vidni živac napušta oko). Ispadi vidnog polja se pojavljuju vrlo rano, ispadi se šire od periferije prema središtu pa bolesnici imaju suženo vidno polje; gledaju kao kroz dvocjevku ili tunel. Završetak procesa je sljepilo. Kronični glaukom širokog kuta je podmukla bolest koja napada oba oka. Dugo vremena može biti bez simptoma ili s vrlo malo simptoma, npr. nejasnim glavoboljama. Od ove bolesti boluje oko 2% osoba starijih od 40 godina, a zahvaća podjednako oba spola. Bolesti: dijabetes, vaskulopatije, hipertenzija dodatni su rizični čimbenici za pogoršanje prognoze, a osobito su ugrožene osobe kojima članovi obitelji imaju glaukom. Ispadi vidnog polja se ne mogu liječiti. Liječenjem se postiže normalizacija očnog tlaka i eventualno sprječavanje daljnjeg propadanja vidnih funkcija. Sužen kut nalazi se kod plitke očne sobice. Takva građa oka je genetski određena (npr. kratko, dalekovidno oko) ili nastaje zbog povećane leće. Suženi kut lako se može zatvoriti korijenom šarenice, nastaje zapreka otjecanju očne vodice i posljedično povišenje očnog tlaka. Uzroci takovog povišenja tlaka su: naglo širenje zjenice uzrokovano sumrakom, emocijama, mlohavi šarenični korijen ili povećana prokrvljenost zrakastog tijela. Zapreka otjecanju očne vodice može biti nagla (akutna), povremena (intermitentna) ili dugotrajna (kronična). Akutna manifestacija je vrlo burna, za razliku od kroničnog glaukoma, i zahtijeva hitnu intervenciju. Na izgled zdrav čovjek postaje težak bolesnik: Ukoliko se očni tlak ne snizi unutar nekoliko sati pomoću lijekova ili operativnog zahvata može doći do ozbiljnih i trajnih oštećenja vida. Glaukomski napadaji mogu biti slabiji i češće se ponavljati. Kronični glaukom zatvorenog kuta obično nastaje kao posljedica učestalih neliječenih glaukomskih napadaja i posljedičnih priraslica u kutu prednje sobice. Očni je tlak stalno povišen, razvija se udubljenje i propadanje papile očnog živca s ispadima vidnog polja te konačno nastaje sljepoća. Kratko vrijeme prije rođenja nestaje tkivo u kutu prednje očne sobice i tako se jasno razdvajaju šarenica, rožnica i strukture sobnog kuta. Ako navedeno tkivo postoji u većoj količini nakon rođenja, može blokirati otjecanje očne vodice i povisiti očni tlak. Simptomi ovise o visini očnog tlaka i svojstvima bjeloočnice. Pri visokom očnom tlaku bjeloočnica se rasteže i oko postaje izrazito veliko, što se naziva hidroftalmus ili buftalmus (volovsko oko). Stanje je obično jednostrano. Povećanje očne jabučice može biti vrlo izrazito te se može dogoditi njeno pucanje i pri najmanjoj traumi. Oko je izrazito osjetljivo na svjetlost (fotofobija) pa dijete pogled i glavu okreće u suprotnu stranu od izvora svjetlosti. Bolest može imati i blaži tok s manjim rastezanjem oka. Znakovi glaukoma mogu se očitovati i kasnije, kad oko očvrsne. Vrijeme i način očitovanja kongenitalnog glaukoma uglavnom su genetski uvjetovani. Ovaj naziv označuje slijepo oko. Sljepoća može nastati kao posljedica svih oblika glaukoma i označava završni stadij njegova napredovanja. Oko tada može biti izrazito bolno. Nakon razgovora s pacijentom obavljaju se pregled oka i pretrage. Pretrage koje se obavljaju su određivanje vida, pregled oka procjepnom svjetiljkom (biomikroskopom), pregled oftalmoskopom (pregled unutrašnjih struktura oka, koji pokazuje, za glaukom tipične, promjene na očnom živcu), tonometrija (mjerenje očnog tlaka), određivanje vidnog polja (periferni i centralni vid) i gonioskopija (leća koja se postavlja na oko kako bi se vidjelo stanje očnog kuta). Prije oftalmološkog pregleda bitno je liječnika obavijestiti je li netko od obitelji ili rođaka bolovao ili boluje od glaukoma. Liječenje glaukoma provodi se lijekovima, laserom i kirurškim zahvatom. Svrha liječenja lijekovima je normalizacija povišenog očnog tlaka. Na taj način se sprječava razvoj oštećenja oka iako je osnovna bolest i dalje prisutna. Cilj je održavati očni tlak nižim od 20 mmHg. Vrlo je važno lijekove doživotno uzimati. Glaukom često nema simptoma, obično glaukom otvorenog kuta pa bolesnici prestanu uzimati lijekove. To je velika pogreška jer bolest, ako se ne liječi, nezaustavljivo vodi prema sljepoći. Glaukom otvorenog kuta Liječi se kapima za oči: Ova bolest zahtijeva doživotnu terapiju čija se djelotvornost provjerava redovitim mjerenjem očnog tlaka. Aktivnostima u svakodnevnom životu ne treba postaviti nikakva ograničenja. Nema dokaza da bi određena hrana, piće, kava, kino, televizija, čitanje, vožnja itd. ubrzali tok i razvoj glaukoma. Važno je držati pod kontrolom čimbenike rizika: hipertenzija, atersokleroza, dijabetes, hormonske bolesti jer one znatno pogoršavaju prognozu. Glaukom zatvorenog kuta Akutni glaukom se smatra jednim od najhitnijih stanja u oftalmologiji. U terapiji akutnog glaukoma koriste se sljedeći lijekovi: Sredstvo za sužavanje zjenice pilokarpin (Pilocarpin 2% sol.) ispočetka (1-2 sata) se ukapava svakih 15 minuta, a zatim 4 puta na dan da se izvuče korijen šarenice iz komornog kuta, a djelovanjem na cilijarni mišić širi “pore” u sobnom kutu i olakšava otjecanje sobne vodice. Iako je pilokarpin uveden 1876. god. još je uvijek glavni antiglaukomatozni lijek. Timolol maleat (Metablen) 0.5% kapi 2 puta na dan, beta-blokator koji smanjuje stvaranje sobne vodice, može se nadodati mioticima. Inhibitori karbonske anhidraze kao acetazolamid (Diamox) – smanjuje stvaranje sobne vodice do 50%. Daje se na usta (1-4 puta na dan, 250 mg tbl.) ili intravenski (500 mg). Glicerin na usta (1.2 g/kg u 50% otopini hladne vode, po mogućnosti s dodatkom limunova soka radi boljeg okusa), lijek koji smanjuje tlak i volumen staklovine. Hipotenzivni efekt, ali puno blaži, postiže se i etilnim alkoholom (viski, konjak, vinjak). Manitol 20%, hiperosmotski je lijek i daje se intravenski u dozi od 1.5 g/kg 30-40 min. Lokalno kapanje kortikosteroida (deksametazon 0.1% kapi 3-4 ´ na dan) vjerojatno je od pomoći za smanjenje oštećenja šarenice i struktura sobnog kuta. Sustavni analgetici (npr. Aspirin 500 mg 3-4 puta na dan). Kada se očni tlak stavi pod kontrolu, kirurški se načini periferna iridektomija ili laserska iridotomija (argonskim ili Nd:YAG laserom) da se spriječi ponovni napadaj. Međutim, neki bolesnici kad prestane napadaj odbijaju operaciju. Štoviše, na dugom oku se također treba raditi preventivna periferna iridektomija (jer će u 40-80% slučajeva dobiti akutni atak unutar 5-10 godina). Ako je više od 50% komornog kuta zatvoreno priraslicama, radi se trabekulektomija. Povremeno zatvaranje očnog kuta praćeno je blažim simptomima. Terapija je slična, ali u manjim dozama. Terapijsko rješenje je kirurški zahvat. Kronični glaukom zatvorenog kuta je terapijski problem jer sredstva za suženje zjenice tu obično ne djeluju zbog priraslica u sobnom kutu, a ostali lijekovi imaju djelomičan i prolazan učinak. Lijekovima se treba postići što bolja podloga za kirurški zahvat. Sekundarni glaukom Mogu se ukapavati sredstva koja smanjuju izlučivanje sobne vodice, a ne šire zjenicu (timolol) uz primjenu osmotskih sredstava (manitol, glicerol) i/ili acetazolamida. Osnovna bolest koja uzrokuje glaukom često zahtijeva kirurški zahvat. Prirođeni glaukom Metoda liječenja kod ove djece je kirurški zahvat. Lijekovi na djecu mogu imati upitan učinak i teško ih je davati. Kirurški je zahvat siguran i učinkovit, a ako se učini odmah velike su mogućnosti da će dijete kasnije imati dobar vid. Laserska terapija Laserom se rade slijedeći zahvati: Bazalna iridektomija je probijanje šarenice. Provodi se kod glaukoma zatvorenog kuta preventivno ili u napadu. Obično se s nekoliko desetaka laserskih pečata na uskom području može probiti šarenica. Krvarenja nema jer laserska zraka zgrušava krvne žile. Trabekuloplastika je zgrušavanje trabekula, područja u sobnom kutu. Radi se kod kroničnog glaukoma širokog kuta. Diskretni ožiljci koji tako nastaju istežu pore i olakšavaju protok tekućine. Očni se tlak snizi prosječno za 8 mmHg, a po potrebi se postupak može ponoviti. Gonioplastika je korekcija deformacija sobnog kuta (priraslica). Principi laserske terapije Laserska kirurgija radi se u svrhu pomaganja otjecanja očne vodice iz oka. Iako očni liječnik, oftalmolog, može preporučiti ovaj oblik liječenja u svako doba, obično se radi nakon određenog vremena liječenja lijekovima. U mnogim se slučajevima glaukomski lijekovi trebaju uzimati i nakon laserske kirurgije. Laserska kirurgija se provodi u ordinaciji oftalmologa ili u očnim klinikama. Prije zahvata se u oko kapaju lijekovi koji paraliziraju zjenicu. Nakon primjene lasera liječnik provjerava očni tlak, a može dati kapljice za kasnije ako se pojavi bol ili oteklina oka. Potrebno je nekoliko kontrola očnog tlaka nakon toga. Istraživanja pokazuju kako je laserska kirurgija vrlo učinkovita, međutim njeni efekti mogu prestati s vremenom. Dvije godine nakon laserske kirurgije očni se tlak povećava u više od polovine bolesnika. Kirurški zahvat Operacijom se prave novi putovi za otjecanje očne vodice. Uspostavlja se izravna veza između prednje očne sobice i vanjske površine oka ili se radi izrezivanje šarenice. Zahvat ne ostavlja otvorenu rupu u oku jer se novostvoreni kanal otvara ispod očne spojnice. Nakon zahvata potrebno je nekoliko tjedana stavljati kapi u oko kako bi se smanjilo oticanje i bol. Operacije su uspješne u 80-90% bolesnika, a ako se stvoreni kanal zatvoreni potrebna je ponovna operacija. Važno je da ovi kirurški zahvati ne popravljaju vid već zaustavljaju daljnje propadanje vida. Vid nakon operacije može biti i lošiji nego prije. Komplikacije operacije mogu biti: očna mrena, bolesti rožnice, upala unutrašnjosti oka, oticanje krvnih žila iza oka. Za sve ove probleme postoje učinkovita liječenja.