Glaucoma Surgery

• Bleeding inside your eye, which usually clears up on its own.
• Blurring of sight, which is usually temporary.
• Over-drainage causing low pressure. This can make sight blurred and create a shadow. This is usually temporary.
• Scarring, which causes pressure to rise.
• Formation of cataract, which may need removal at a later stage.
• Loss of sight. This is rare. If the glaucoma is already very bad, the sight can suddenly vanish.

• There are three ways to lower the pressure inside the eye on a long-term basis: eye drops, lasers and operations.
• You may already be using eye drops, but they did not lower the eye pressure enough, you are getting side-effects.
• Generally, an operation is reserved for patients in whom eye drops and lasers have not worked or are not suitable.

Your eye surgeon will explain to you how the disease work and explain the risks of not having treatment. Your eye surgeon will recommend more eye drops to lower the pressure in your eye, or a laser procedure.

General anaesthetic, or local anaesthetic, may be appropriate for your surgery. General anaesthetic is a drug-induced unconsciousness.

It is always provided by an anaesthetist, who is a doctor with specialist training. Local anaesthetic is a drug-induced numbness: it may be provided by an anaesthetist, surgeon or other healthcare professional, depending on the technique used.

Unfortunately, both local and general anaesthetic can cause side effects and complications. Side effects are common, but are usually short-lived: they include nausea, confusion, and pain. Complications are very rare, but can cause lasting injury: they include awareness, paralysis and death.

Unfortunately, both local and general anaesthetic can cause side effects and complications. Side effects are common, but are usually short-lived: they include nausea, confusion, and pain. Complications are very rare, but can cause lasting injury: they include awareness, paralysis and death.

You will be seen in the Pre-Operative Assessment clinic before you are admitted to the hospital. This is usually within twelve weeks of your operation. This assessment takes place in the Day ward.

Depending on the type of anaesthetic you will be given, the following tests maybe required: Blood, heart, weight & vision test.

• It may be necessary for you to undress to the waist and wear a hospital gown to undertake these tests. Female patients will need to remove tights. Lockers are provided.
• These tests are very important for you. It is better to find out about any problems at this stage than to come into hospital expecting to have an operation, only to be told it has been postponed for medical reasons.
• If there are any complications, our doctors will refer you to the appropriate hospital specialist or to your family doctor (GP). You will be told this is the case.

You will be encouraged to ask questions and talk about your condition and operation. A qualified ophthalmic nurse will explain your care in detail using a specially designed care program.

• You will either come into the hospital the day before or the day of your operation.
• Please leave all cash and valuables at home. If you need to bring valuables into hospital, these can be sent to General Office for safekeeping.
• General Office is open between 08:30 am and 4:30 pm Monday to Friday. Therefore, if you are discharged outside these times, we will not be able to return your property until General Office is open. The Trust does not accept responsibility for items not handed in for safekeeping.
• You will be asked to remove jewellery – plain rings can be worn but they will be taped.
• Please leave body piercings at home. False nails and nail polish will also need to be removed if worn.
• If you are on regular medication, you will be told to take this if necessary.
• You will be asked to put on a gown.
• If you are having a local anaesthetic, you may have a light meal before your operation, for example toast and cereal. If you are having a general anaesthetic, you will have been given instructions before you come into hospital.
• A bracelet with your personal details will be attached to your wrist.
• You may be prescribed some medication to take before your operation by the anaesthetist. A member of the nursing staff will give this to you.
• A nurse and porters will take you to the operating theatre.
• Your dentures, glasses or hearing aid can stay with you on your journey to the operating theatre.
• When you arrive in theatre, you will then be asked to put on a disposable hat and the ward nurse will then leave you.
• You will be taken to the anaesthetic room and a member of theatre staff will check your details with you.

• You can expect to be in hospital for half a day. Occasionally, we keep you in overnight, but this is unusual.
• We freeze the eye with an injection. You can request a tablet to help you relax or you may have chosen sedation.
• You can have a general anaesthetic so that you sleep through your operation.
• The operation takes about an hour.
• Occasionally, the surgery is combined with a cataract operation.

Glaucoma surgery is successful 80-90% of the time, though sometimes you may need to go back on to glaucoma drops to lower the eye pressure further.

Factors that reduce the success rate of surgery include being a young patient, black race, previous eye surgery or inflammation, diabetes or trauma.

Following the procedure, we would make an appointment to see you in one day, one week, one month, three months and then six monthly thereafter. If you have a trabeculectomy you may need to attend every week for the first six weeks. You may require removal of stitches during this time, which is part of routine care.

We may ask you to come more frequently if we have any concerns that need addressing.

As with any operation, glaucoma surgery can have complications, though these are rare.

These include infections, bleeding, too high or low pressure in the eye, repeat surgery and very rarely, loss of sight. Sometimes we cannot stop glaucoma getting worse.

Overall, these procedures are performed regularly, work well and their complications managed effectively should they arise.

• After surgery, we will pad the eye overnight. The eye usually feels a bit sore and scratchy for the first few days. Take some painkillers as necessary.
• The sight is blurred for 2-3 weeks. This is normal.

• After your operation, you will be kept in the theatre recovery room before being transferred back to the ward.
• A nurse will check your pulse, blood pressure, breathing rate, and wound regularly.
• The nursing staff will also advise you when you can start taking sips of water. Anaesthetics can make some people sick. If you feel sick, we advise you not to drink until this feeling has passed.
• The nursing staff may offer an injection to help this sick feeling go away.
• On arrival back to the ward, eye drops may be applied by the nursing staff. Also, you will be wearing an eye pad until the next morning.
• The first time you get out of bed, please make sure you ask a nurse to be with you. This is in case you feel dizzy.

• The nursing staff will advise you about painkillers before you leave the hospital. Please tell the nurses what painkilling tablets you have at home.
• Continue any oral medications prescribed by the doctors.
• You will need to regularly insert eye drops following your operation. This will vary from patient to patient. These drops include a steroid drop (such as forte) to help the eye heal and perhaps antibiotic (such as Chloramphenicol) or pupil-dilating drops (such as Cyclopentolate or Atropine). You will no longer need your glaucoma drops in the operated eye, unless you are having the Cyclodiode laser treatment, in which case you usually continue your glaucoma drops. All drops must continue in the eye which has not had surgery.
• Please wash your hands both before and after applying eye drops.
• Apply your drops at the correct times.
• A member of the nursing staff will show you how to apply your drops.

This varies. If you have a local or general anaesthetic, you may come in and go home on the same day (day case surgery).

If so and you have had a general anaesthetic and/or sedation, you must have a friend or relative to take you home and have a responsible adult to stay with you for 24 hours.

• Travel alone.
• Drive any vehicle until instructed by your surgeon.
• Operate machinery (including domestic appliances such as kettle).
• Climb ladders.
• Make important decisions, sign any business or legal documents.
• Drink alcohol.
• Return to work within 12 hours of treatment. Your general health and any medicines you are taking may increase the time you need off work.

• Take it easy for the rest of the day, avoid strenuous activity (bending or heavy lifting for two weeks).
• Take your medications as usual.
• Let someone else care for anyone you usually look after, such as children or elderly or sick relatives.

For two weeks after the operation please:

• Avoid rubbing or pressing on your eye.
• Avoid heavy lifting, strenuous exercise, or heavy gardening.
• Avoid getting soap or shampoo in your eye while washing.
• Avoid eye makeup.

For the first two or three months after your operation your sight will vary while your eye settles down. You will also be tested to see if you need new glasses at this stage.

Sutures may be removed. This is usually done under local anaesthetic drops at your follow-up appointments.

Remember that you have just had an operation. It is normal to feel more tired than usual for a few days afterwards.

• You can self-certify for the first seven days of sickness. Before you are discharged, a medical certificate (Fit Note) may be issues by your hospital doctor to cover the expected time off you will need.
• Please check with the medical staff at your outpatient appointment when you can return to work.

An outpatient appointment will be given to you before you are discharged from the hospital.

Your feedback is important to us and helps us influence care in the future.

Following your discharge from hospital or attendance at your Outpatient appointment you will receive a text asking if you would recommend our service to others. Please take the time to text back, you will not be charged for the text and can opt out at any point. Your co-operation is greatly appreciated.