The Goal of All Glaucoma Treatment: Lower Intraocular Pressure
The optic nerve - the bundle of fibres that carries visual information from the eye to the brain - is damaged in glaucoma by sustained elevated intraocular pressure (IOP). In some patients, damage occurs even at statistically normal pressures; in others, high pressure causes no damage. Every case is individual.
Treatment is targeted at the pressure, not the nerve damage itself. Once optic nerve fibres are lost, they do not regenerate. This is why starting treatment early is the most important decision a glaucoma patient can make.
At Eye One Centre, Kangra, every glaucoma patient receives a personalised target pressure - the level at which their specific optic nerve should be stable. Treatment is then stepped up or adjusted until that target is consistently reached.
Option 1: Prescription Eye Drops
Eye drops are almost always the first line of treatment for newly diagnosed glaucoma. They work by either reducing the amount of fluid (aqueous humour) the eye produces, or improving the rate at which fluid drains out - or both.
Prostaglandin Analogues (e.g. Latanoprost, Bimatoprost)
These are the most commonly prescribed glaucoma drops globally. They improve fluid drainage through a secondary pathway in the eye called the uveoscleral route. Typically used once daily at bedtime. They are highly effective and well-tolerated in most patients.
Beta-Blockers (e.g. Timolol)
Reduce the production of aqueous fluid inside the eye. Often used in combination with prostaglandins when a single drop is insufficient. Should be used with caution in patients with asthma, heart conditions or low blood pressure.
Alpha-2 Agonists (e.g. Brimonidine)
Reduce fluid production and also increase drainage. Useful as add-on therapy. Some patients experience local allergy with long-term use.
Carbonic Anhydrase Inhibitors (e.g. Dorzolamide, Brinzolamide)
Reduce fluid production by blocking an enzyme involved in its formation. Available as eye drops or, for short-term use, as oral tablets. Eye drops are used as add-on therapy when other drops are insufficient.
Fixed Combination Drops
Several drops are available in pre-mixed combinations - two drugs in a single bottle. These reduce the number of bottles a patient needs to manage and improve the consistency of treatment.
What Eye Drop Patients Need to Know
Consistency is everything. Glaucoma drops must be used every day, at the same time, without interruption. Missing doses allows pressure to rise. Stopping drops is not a decision to make without specialist guidance.
Drops control, not cure. Pressure is only controlled while drops are being used. Stopping them allows IOP to return to its untreated level.
Side effects are manageable. Most patients tolerate drops well. If you experience redness, stinging or systemic effects, inform your specialist - an alternative drug may be more suitable.
Regular review is essential. Drops need to be monitored for effectiveness - some patients respond well initially and then less so over time. Pressure reviews every 3-6 months are standard.
Option 2: Laser Treatment
Laser is an increasingly important part of glaucoma management. It is performed in the clinic, takes a few minutes, and does not require surgery or hospital admission. Two procedures are most commonly used:
Selective Laser Trabeculoplasty (SLT)
SLT targets the trabecular meshwork - the drainage tissue in the angle of the eye - using short pulses of low-energy laser. This stimulates the drainage tissue to function more effectively, reducing IOP.
SLT is safe, repeatable and increasingly used as a first-line treatment for open-angle glaucoma - in some cases before drops are started, particularly in patients who are likely to struggle with drop adherence.
- Performed in clinic, no anaesthetic injection required
- Takes approximately 5-10 minutes per eye
- Pressure-lowering effect typically seen within 4-8 weeks
- Can be repeated if the effect diminishes over time
- Well-tolerated with minimal discomfort
Laser Peripheral Iridotomy (LPI)
Used specifically for angle-closure glaucoma or narrow-angle eyes at risk of closure. A small laser opening is created in the peripheral iris to allow fluid to flow freely between the front and back chambers of the eye, relieving or preventing dangerous pressure spikes.
LPI is often performed as a preventive procedure in eyes where the drainage angle is found to be narrow on examination - before acute angle-closure occurs. It is a simple, safe and highly effective procedure.
🔗 Glaucoma services at Eye One Centre: Advanced optic nerve imaging, visual field testing, SLT laser and surgical glaucoma care in Kangra.
Option 3: Glaucoma Surgery
When eye drops and laser are insufficient to control pressure adequately, surgery is the next step. The goal of glaucoma surgery is to create a new or improved drainage pathway for fluid to leave the eye, bringing pressure down to a sustainable level.
Trabeculectomy
Trabeculectomy is the most established glaucoma surgery globally and remains the gold standard for advanced or medically uncontrolled glaucoma. A small flap is created in the wall of the eye (the sclera), and a drainage bleb - a small reservoir under the conjunctiva - is formed to allow fluid to drain continuously.
Trabeculectomy can achieve significant and sustained pressure reduction, often reducing or eliminating the need for drops afterwards. It requires careful post-operative management and regular review in the weeks following surgery.
Minimally Invasive Glaucoma Surgery (MIGS)
MIGS represents a newer category of surgical approaches designed to lower pressure with a better safety profile and faster recovery than traditional filtration surgery. Several MIGS procedures are available, including:
- iStent / Hydrus microstent - tiny devices implanted in the drainage angle to improve outflow
- PRESERFLO MicroShunt - a small tube that redirects aqueous fluid under the conjunctiva
- Gonioscopy-assisted transluminal trabeculotomy (GATT) - opens the drainage canal directly
MIGS procedures are often performed at the same time as cataract surgery in patients who have both conditions - treating both in a single operation.
Glaucoma Drainage Devices (Tube Shunts)
In complex or refractory cases where trabeculectomy has failed or is unsuitable, a tube is implanted to redirect fluid from the eye to a small plate on the surface of the eye. This provides reliable long-term pressure control in challenging cases.
Combined Cataract and Glaucoma Surgery
Many glaucoma patients are over 55 and will develop cataract as they age. When both conditions are present and both need treatment, performing them in a single combined operation has significant advantages.
- One surgery instead of two - reduced overall risk and recovery burden
- Cataract removal itself can lower IOP slightly by deepening the anterior chamber
- MIGS devices can be implanted simultaneously with phaco cataract surgery
- Trabeculectomy can be combined with cataract surgery in selected cases
Dr. Gitanjli Sood Sirkek has specific expertise in combined cataract-glaucoma procedures. Her background in both vitreo-retinal surgery and anterior segment care means she approaches complex combined cases with a depth of understanding that few surgeons in the region can match.
🔗 Need cataract surgery too? Read about phaco cataract surgery at Eye One Centre, Kangra and how it can be combined with glaucoma treatment.
How Is the Right Treatment Chosen for You?
Glaucoma treatment is not one-size-fits-all. The choice of treatment depends on:
- Type of glaucoma - open-angle, angle-closure, normal tension, secondary, congenital
- Stage at diagnosis - early, moderate or advanced optic nerve damage
- Rate of progression - fast-progressing glaucoma needs more aggressive pressure targets
- Patient's target IOP - calculated individually based on baseline pressure and nerve status
- Adherence ability - a patient who genuinely cannot manage daily drops may benefit from laser as primary treatment
- Co-existing conditions - particularly cataract, which may influence surgical planning
- Overall health - certain systemic conditions affect which drops are safe to use
At Eye One Centre, Kangra, every glaucoma patient undergoes a comprehensive workup before any treatment decision is made. This includes intraocular pressure measurement, optic nerve OCT imaging, visual field testing, gonioscopy, and pachymetry (corneal thickness). The findings are reviewed together to determine the most appropriate management plan.
Glaucoma Care at Eye One Centre, Kangra
Dr. Gitanjli Sood Sirkek - Glaucoma Specialist, Eye One Centre, Kangra
MS Ophthalmology · DNB · FMRF Vitreo-Retina (Sankara Nethralaya) · FICO UK (Merit) · FRCG II Glasgow
15,000+ cataract surgeries · 5,000+ retinal surgeries · Expert in combined cataract-glaucoma procedures · Advanced optic nerve and visual field assessment
View full credentials and profile →
Patients diagnosed with glaucoma at Eye One Centre, Kangra receive a structured long-term care plan from the first visit. This includes:
- A personalised IOP target based on your optic nerve status and rate of progression
- Treatment selection - drops, laser or surgery - explained clearly with the rationale for the recommendation
- Regular pressure and optic nerve reviews at appropriate intervals (typically every 3-6 months)
- Visual field monitoring to track whether progression has been halted
- Prompt escalation of treatment if the initial approach is not achieving the target
- Full continuity of care in Kangra - no need to travel out of state for routine glaucoma management or surgery
🔗 Why choose Eye One for glaucoma? Read our guide on choosing the best eye specialist in Kangra and what Dr. Gitanjli's international training means in practice.
Glaucoma Treatment at a Glance: Which Option for Whom?
Treatment Selection Overview
Eye Drops: Best for newly diagnosed, mild-to-moderate glaucoma. All types. Long-term use required. High effectiveness when used consistently.
SLT Laser: Open-angle glaucoma. First-line or add-on. Repeatable. Good for patients who struggle with drop adherence or want to reduce drop burden.
LPI Laser: Angle-closure glaucoma or narrow-angle risk. Preventive or therapeutic. Protects the fellow eye.
MIGS Surgery: Mild-to-moderate glaucoma. Often combined with cataract surgery. Faster recovery than trabeculectomy. Less pressure reduction than filtration surgery.
Trabeculectomy: Advanced or medically uncontrolled glaucoma. Significant, sustained pressure reduction. Requires careful post-operative monitoring.
Combined Cataract-Glaucoma Surgery: When both conditions are present and both require treatment. Single operation, reduced total risk.
Final Thoughts
Glaucoma is a lifelong condition. It does not have an end point at which treatment stops. But it does have a management pathway - one that, followed consistently with a specialist you trust, allows most patients to keep meaningful vision for their lifetime.
The most important step is not choosing between drops, laser or surgery. It is choosing to start. Every month of untreated or inadequately treated elevated pressure is a month of potential optic nerve damage that cannot be recovered.
At Eye One Centre, Kangra, we see glaucoma patients at every stage - early diagnosis, long-term management, and complex cases requiring surgery. The treatment you receive will be specific to your eyes, your pressure, your nerve, and your life. Not a protocol. A plan.
Book a Glaucoma Consultation at Eye One Centre, Kangra
Newly diagnosed, already on treatment, or overdue a pressure review - we are here for all of it.
→ Glaucoma treatment at Eye One Centre, Kangra
→ Meet Dr. Gitanjli Sood Sirkek - glaucoma specialist
Serving Kangra, Dharamshala, Palampur, Hamirpur, Mandi, Una and all of Himachal Pradesh.