Glaucoma Treatment: How Is High Eye Pressure Treated?
Why does eye pressure rise? What is the difference between open-angle and narrow-angle glaucoma? Glaucoma treatment with drops, laser or surgery depends on the situation.
Eye pressure rises when the balance between production and drainage of the fluid inside the eye is disturbed. Glaucoma treatment depends on the type of glaucoma. In open-angle glaucoma, the first choice is usually eye drops or selective laser trabeculoplasty (SLT). If these are not enough, surgery follows. In narrow or closed angles, laser iridotomy or surgery comes first. Glaucoma often narrows the visual field without any symptoms. Therefore, regular eye pressure checks matter after age 40.
Why does eye pressure rise?
A clear fluid (aqueous humor) fills the front of the eye. The ciliary body behind the iris produces it continuously. The fluid passes through the pupil. Then it drains through a sieve-like tissue (the trabecular meshwork) in the angle where the iris meets the cornea. Pressure can rise for three reasons:
- Too much fluid is produced (less common)
- The sieve-like tissue does not let enough fluid through: open-angle glaucoma
- The angle is anatomically narrow or closes: narrow / closed-angle glaucoma
“High eye pressure is a sneaky disease. Treatment changes depending on whether the angle is open or closed. Most importantly, never skip your check-ups.”
— Prof. Dr. Fırat Helvacıoğlu, from his video explanation
Glaucoma treatment
In 1 minute, Prof. Dr. Fırat Helvacıoğlu explains the causes of high eye pressure and the treatment options.
How does eye pressure rise?
The fluid inside the eye is produced in the ciliary body behind the iris. It passes through the pupil and drains through the angle where the iris meets the cornea. If the balance between production and drainage is disturbed, eye pressure rises.
- Normal flowThe fluid is produced and drains through the sieve-like tissue (trabecular meshwork) in the angle. As a result, pressure stays balanced.
- Open-angle glaucomaThe angle is open, but the sieve-like tissue does not let enough fluid through. It progresses silently, and treatment usually starts with drops.
- Narrow or closed angleThe iris bulges forward and narrows or closes the angle. Laser or surgery comes first in treatment.
Why is glaucoma a “sneaky” disease?
In glaucoma, high pressure damages the optic nerve. The damage starts at the edges of the visual field. Central vision stays intact for a long time, so most people notice nothing. However, a lost visual field does not come back. For this reason, early diagnosis is more valuable in glaucoma than in almost any other eye disease.
Experts estimate that the number of people with glaucoma will reach 111.8 million worldwide by 2040. In a large study, researchers followed people with high eye pressure but no nerve damage yet. Drop treatment lowered the rate of developing glaucoma within 5 years from 9.5% to 4.4%. In other words, treatment started early is effective in preventing vision loss.
Glaucoma treatment in open-angle glaucoma
| Treatment | How does it work? |
|---|---|
| Eye drops | They reduce fluid production or increase drainage. They are the first choice for most patients, and you must use them regularly every day. |
| Selective laser trabeculoplasty (SLT) | A brief laser applied to the sieve-like tissue makes drainage easier. In a large study, most patients who received SLT as first treatment stayed under control without drops for 3 years. |
| Surgery | If drops and laser do not lower the pressure enough, the surgeon creates a new drainage path for the fluid (trabeculectomy, a tube or less invasive methods). |
Drops only work when you use them regularly. Missed doses can raise the pressure again. If you have side effects, talk to your doctor instead of stopping the drops. Alternative medications or laser options exist.
Glaucoma treatment in narrow and closed angles
The angle of the anterior chamber can be narrow, especially in farsighted and short eyes. If the risk of angle closure is high, a small laser hole in the iris (laser iridotomy) opens a second pathway for the fluid. In one study of people with narrow angles found by community screening, the protective effect of this laser was modest. Therefore, the decision is individual, and it depends on how narrow the angle is and on risk factors.
Acute angle closure: an emergency
- Sudden, severe eye pain and redness
- Colored halos around lights and blurred vision
- Headache, nausea and vomiting
These symptoms need treatment the same day. The lens of the eye also thickens and plays a role in angle closure. For this reason, cataract surgery can widen the angle and become part of the treatment in some patients.
Glaucoma treatment needs lifelong follow-up
- Measurement of eye pressure
- Visual field test
- Examination of the optic nerve and nerve fiber layer with OCT
- Evaluation of the anterior chamber angle
Regular eye pressure checks are especially important after age 40. They also matter for people with a family history of glaucoma, high myopia or hyperopia, and long-term cortisone use. You can find more details on the glaucoma (high eye pressure) page.
Frequently asked questions
Glaucoma is usually a lifelong disease, but treatment keeps it under control. The goal is to prevent further damage to the optic nerve.
Most patients do. However, laser or surgery can reduce the need for drops in some patients, or remove it.
Open-angle glaucoma usually causes no symptoms. Acute angle closure, however, shows up as sudden pain, redness, blurred vision and nausea.
Usually 10–21 mmHg counts as normal. However, the target pressure differs for each eye. The doctor also considers corneal thickness and the condition of the optic nerve.
Untreated glaucoma can lead to permanent vision loss. With early diagnosis and regular treatment, most patients keep their vision.
Related pages
References
- Tham YC, Li X, Wong TY, Quigley HA, Aung T, Cheng CY. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology. 2014;121(11):2081-2090. doi:10.1016/j.ophtha.2014.05.013
- Kass MA, Heuer DK, Higginbotham EJ, et al. The Ocular Hypertension Treatment Study: a randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. Arch Ophthalmol. 2002;120(6):701-713. doi:10.1001/archopht.120.6.701
- Gazzard G, Konstantakopoulou E, Garway-Heath D, et al. Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial. Lancet. 2019;393(10180):1505-1516. doi:10.1016/S0140-6736(18)32213-X
- He M, Jiang Y, Huang S, et al. Laser peripheral iridotomy for the prevention of angle closure: a single-centre, randomised controlled trial. Lancet. 2019;393(10181):1609-1618. doi:10.1016/S0140-6736(18)32607-2
This article is for patient information only. It does not replace an examination or medical evaluation. Your suitable treatment is decided after an eye examination and measurements. Publication date: September 25, 2026.
Contact Prof. Dr. Fırat Helvacıoğlu with your questions
Prof. Dr. Fırat Helvacıoğlu · Veni Vidi Eye Clinic, Bağdat Cad. No: 257, Caddebostan – Kadıköy / Istanbul