Glaucoma treatment in Nigeria: drops, laser or surgery?

What glaucoma does

Glaucoma damages the optic nerve, the cable that carries sight from the eye to the brain, usually because the pressure in the eye is too high for that nerve. The common type causes no pain and starts at the edges of vision, so most people do not notice until a lot of sight has gone. It is more common, and often starts younger, in people of African heritage, and it runs in families.

If a parent, brother or sister has glaucoma, get your own eyes checked, even if you see well.

Eye drops

Drops are the usual first treatment. Most are used once or twice a day, every day, for life. They work only while you use them. The most common reason glaucoma gets worse in Nigeria is not that the drops failed, but that they ran out, cost too much, or were stopped because the eye felt fine.

• Use them at the same times each day, and keep a spare bottle so you never run out
• Close the eye and press gently on the inner corner for a minute after each drop
• Tell your doctor about side effects such as red, itchy eyes, rather than stopping
• Bring all your bottles to every check-up

Laser

UK guidance now offers a laser treatment, called selective laser trabeculoplasty, as a first option for many people with the common type of glaucoma or high eye pressure. It is done in clinic, with numbing drops, and takes minutes. It helps the eye drain fluid better. For some people it means fewer drops or none for a time, but the effect can wear off, and it can be repeated.

A different laser is used for the narrow-angle type of glaucoma, to make a small opening in the iris so fluid can flow. Whether laser suits you depends on the type of glaucoma, and your specialist will tell you.

When surgery is the answer

An operation is usually considered when the pressure stays too high despite drops and laser, when the damage keeps progressing at check-ups, when someone cannot use drops reliably, or when the glaucoma is already advanced at diagnosis. The common operation, trabeculectomy, creates a new drainage channel so fluid can leave the eye. Other drainage devices are used in some cases.

Surgery can lower pressure well, but it is a real operation. The eye needs drops and close follow-up for weeks afterwards, and possible problems include pressure that is too low, infection, and the new channel scarring over. Some people still need drops after it. It does not repair the nerve or restore lost sight.

Glaucoma emergencies

Acute angle-closure glaucoma comes on suddenly and can blind an eye within days. Go to an eye emergency service immediately if you have:

• A sudden, very painful red eye
• Blurred vision with headache, nausea or vomiting
• Rainbow-coloured rings around lights

Common questions