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Glaucoma Condition, Treatment, & Surgery

What is Glaucoma?

Glaucoma is a condition where the pressure within the eye exceeds normal levels, potentially damaging the optic nerve. This damage can occur through disrupted blood flow to the nerve or direct harm to the nerve itself. In some cases, the optic nerve may be particularly vulnerable to damage, even when eye pressure is considered normal. To manage and reduce intraocular pressure, eye doctors perform various treatments or surgeries for glaucoma. Those with a family history of this condition are at increased risk and should visit a glaucoma specialist in Singapore for screening to identify signs of high eye pressure or other related symptoms.


Types Of Glaucoma

Understanding the different types of glaucoma is crucial for managing visual health. Here are the types you should be aware of:

Type of Glaucoma

Description

Primary Open-angle Glaucoma

The most common type where the eye’s drainage system is open but not working properly, causing fluid build-up and pressure. This type often has no symptoms until significant vision loss occurs. Regular eye exams are crucial.

Primary Angle-closure Glaucoma

This type involves a sudden closure of the space between the iris and cornea, blocking fluid drainage and quickly raising eye pressure. It’s an emergency that can lead to rapid vision loss if not treated immediately.

Normal-tension Glaucoma

Here, the optic nerve gets damaged even though the eye pressure is normal. It might be linked to other health issues like poor blood circulation or systemic diseases.

Secondary Glaucoma

Caused by other health conditions or medications that increase eye pressure, leading to optic nerve damage. Conditions like eye injuries or diabetes are common causes. Treatment often focuses on the underlying cause.

Pigmentary Glaucoma

Occurs when tiny pigment particles from the iris block the eye’s fluid drainage system, increasing eye pressure. It’s a form of open-angle glaucoma.

Exfoliative Glaucoma

Caused by flaky, dandruff-like material that clogs the eye’s drainage, raising pressure. This type requires regular monitoring and management to control pressure levels.

Neovascular Glaucoma

Abnormal blood vessels on the iris block fluid outflow, often associated with diabetes. This type is serious and needs prompt treatment to manage both the diabetes and eye pressure.

Uveitic Glaucoma

Results from inflammation in the eye, which can block fluid drainage and increase pressure. Treatment may include managing the inflammation and controlling pressure.

Congenital Glaucoma

A rare condition present at birth where the eye’s drainage system hasn’t developed correctly, leading to increased pressure. Early diagnosis and treatment are vital to prevent vision loss.

Symptoms Of Glaucoma

While early-stage glaucoma often shows no noticeable symptoms, it’s crucial to stay alert to subtle changes in your vision and see a doctor promptly. Here are some key symptoms to take notice of:

1. Severe Headaches 

Severe headaches can have various causes but are also a prominent indicator for certain types of glaucoma, particularly angle-closure glaucoma. These headaches usually arise from increased eye pressure, affecting the eyes and surrounding structures, causing pain around the eye that may extend to the temples or back of the head. Such symptoms are critical for early diagnosis and warrant immediate eye examinations.

2. Blurred Vision

Blurred vision may signal several eye conditions; however, if it occurs suddenly and alongside symptoms like eye pain, it could point to acute glaucoma. A medical evaluation by a glaucoma eye specialist in Singapore is essential to diagnose and address this condition promptly.

3. Gradual Loss of Peripheral Vision

A subtle narrowing of your field of vision, especially on the sides, could indicate glaucoma. Often referred to as tunnel vision, this gradual loss of peripheral sight usually goes unnoticed until it becomes more severe, emphasising the importance of regular vision screenings.

4. Halos Around Lights

Noticing halos or bright circles around lights, especially in the dark, can be a sign of glaucoma. This symptom can complicate tasks like driving at night or moving in low-light environments and should be assessed for potential glaucoma treatment options.

5. Eye Pain and Redness

Eye pain accompanied by redness may indicate an urgent type of angle-closure glaucoma. These symptoms are serious and require immediate attention from a glaucoma doctor to evaluate the severity and discuss treatment options, which may include glaucoma laser surgery.

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Glaucoma Diagnosis

Preparing for glaucoma surgery begins with a comprehensive consultation with your eye specialist. In this initial session, the glaucoma doctor will conduct visual field assessments, eye pressure measurements, and corneal thickness evaluations to tailor the surgery to your needs.

A visual field assessment is a common test used to determine glaucoma progression. An automated machine projects light in the patient’s field of vision, and the patient responds by pressing a button when the light is seen. The machine maps the area of functional vision by assessing which parts can and cannot see the light. This process takes about 5-10 minutes per eye and provides the doctor with crucial information about the eye’s function and the optic nerve.

Eye specialist clinics like EyeWise Vision Clinic use the Humphrey Visual Field system, which is considered the gold standard in glaucoma assessment. This system helps collect detailed information for a more comprehensive surgical plan.


Following this, reviewing your current medications with your glaucoma doctor is essential, as some medications could potentially interfere with the surgery. Additionally, fasting may be required before the procedure, so be sure to follow your healthcare team’s guidelines.

Glaucoma Treatment Options

Managing glaucoma involves various treatment options aimed at controlling eye pressure to prevent vision loss. Here’s a closer look at these options:

1. Glaucoma Eye Drops

The initial treatment for glaucoma usually involves using eye drops to reduce eye pressure. Many of these eye drops now come with convenient once or twice-a-day dosing and work for most patients. Sometimes, two or three different types of eye drops may need to be combined to achieve a sufficiently low eye pressure.

2. Glaucoma Surgery

Some patients will need laser or glaucoma surgery to control their eye pressure when even multiple eye drops do not provide satisfactory control. Laser treatment for glaucoma usually involves improving fluid drainage from the eye or reducing fluid production, resulting in a drop in eye pressure.

Glaucoma surgery is typically quick and is done as a day-case procedure. With adequate anaesthesia, patients may not feel discomfort during surgery. Certain chemicals may be used during glaucoma surgery to reduce the amount of scarring at the surgical site. Following surgery or laser treatment, eye drops are prescribed to reduce inflammation and infection and usually need to be used for a few weeks to months.

3. Oral/Intravenous Medications

Intravenous or oral anti-glaucoma medications might be prescribed to reduce high eye pressure, but these should not be used long-term due to the potential side effects on the body.

Post Glaucoma Surgery Guidelines and Recovery

Approaching the post-surgery phase correctly is vital to prevent aggravation. Patients are generally advised to avoid strenuous activities and follow a prescribed regimen of eye drops to control inflammation and infection. Regular follow-up appointments for glaucoma surgery in Singapore are essential for monitoring changes or possible side effects.

During these follow-up visits, the eye doctor will assess several parameters to determine the success of the surgery. This includes a visual field assessment, eye pressure measurements, and the evaluation of the optic nerve hollowing, also known as the cup-disc ratio.

Be vigilant about any unusual symptoms, such as persistent redness, pain, or vision changes, and report them to your eye doctor immediately.

For proper glaucoma preventive measures and treatment, consult a qualified eye specialist at a reputable eye clinic in Singapore today. Additionally, consider diabetic eye screening, as diabetes is a common contributor to glaucoma.

About Dr Christopher Khng

Dr Christopher Khng specialises in Complex Cataract and Anterior Segment Reconstruction Surgery, particularly Iris Reconstruction and Surgery for Aniridia. His other areas of expertise include Complex Lens Surgery, New Lens and Phacoemulsification Technologies, Refractive Surgery, Phakic IOLs (the Implantable Collamer Lens, ICL), and small-incision, topical anaesthesia phacoemulsification cataract surgery.

He completed his first two years of medical undergraduate studies at Aberdeen University, Scotland (UK). Due to cost, he completed his medical degree (MBBS) at the National University of Singapore (NUS).

Dr Khng served as Registrar, then Associate Consultant Ophthalmic Surgeon at the Singapore National Eye Centre (SNEC). Following his tenure at SNEC, Dr Khng was a Consultant at The Eye Institute, Tan Tock Seng Hospital, Singapore.

Dr Christopher Khng brings a comprehensive approach to glaucoma care, offering a variety of treatment modalities. His expertise encompasses both medical and surgical management of glaucoma, including trabeculectomy and laser surgery. With a focus on early detection and appropriate treatment plans, Dr Khng aims to manage the progression of glaucoma to help maintain the vision of his patients.

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Dr Christopher Khng

MBBS, M.Med (Ophth), FRCS (Edin), AMS (Ophth 2003) Consultant Ophthalmologist

Frequently Asked Questions About Glaucoma Treatment

Untreated glaucoma can lead to blindness over several years. However, timely treatment can slow down the progression of vision loss or prevent it altogether. It is important to visit a glaucoma doctor in Singapore for an eye screening to detect glaucoma in its early stages and prevent sight loss.

The recovery period after glaucoma surgery varies depending on the extent of the surgery and the severity of the condition. Some people may see improvements in their vision within days to weeks, while others may take several months.

Regular exercise and a balanced diet rich in omega-3 fatty acids can help maintain eye health and potentially prevent glaucoma. Quitting smoking is also highly recommended for maintaining overall eye health and reducing eye pressure. These lifestyle changes should be monitored by a glaucoma specialist.

Performing glaucoma surgery on both eyes at the same time is generally avoided. This approach allows for better monitoring of recovery and treatment outcomes and helps avoid limited vision during the recovery phase.

The success rate of glaucoma surgery generally ranges from 70% to 90%, but individual outcomes can vary based on the type and severity of glaucoma.

Glaucoma surgery aims to prevent further vision loss rather than fully restore lost vision. Once vision is lost to glaucoma, it cannot be fully restored.

After surgery, it is crucial to adhere to prescribed eye drops and attend regular follow-up appointments with your glaucoma doctor to monitor eye pressure and prevent the condition from worsening.

Yes, children can develop glaucoma, although it is rare. Known as paediatric or congenital glaucoma, early diagnosis and treatment are essential for maintaining vision.

Awareness of potential risks is essential for a well-rounded approach to glaucoma surgery. Here are some possible risks and side effects:

  • Infection: Bacterial exposure during surgery can lead to infections like corneal ulcers or endophthalmitis, which may cause irreversible vision loss if not treated promptly.
  • Scarring: Post-surgery tissue healing can cause scarring that blocks drainage pathways, potentially raising eye pressure and requiring additional treatment.
  • Bleeding inside the eye: Surgery can disrupt fragile blood vessels, leading to internal bleeding and possible vision impairment.
  • Accelerated cataract formation: Surgical intervention can hasten cataract development, causing blurred vision and necessitating earlier cataract surgery.

Understanding these risks helps ensure patients are well-informed and prepared for their glaucoma surgery.