Common Myths About Glaucoma

Most common myth about glaucoma is that it causes pain or obvious vision loss, but early glaucoma is often silent and progresses slowly. Regular eye examinations are important because glaucoma damage can occur long before symptoms become noticeable.
Patients who believe they would notice symptoms, that only older people are affected, or that treatment means surgery are the patients who present late. Here is what is true, explains Dr Shibal Bhartiya.

Glaucoma affects over 12 million people in India. The majority do not know they have it. Part of the reason is the disease itself: silent, slow, and peripheral. But part of the reason is misinformation that creates false reassurance at precisely the moment awareness matters most.

Dr Shibal Bhartiya is a fellowship-trained glaucoma specialist and Mayo Clinic Research Collaborator with over 25 years of experience. Her approach focuses on identifying risk before damage is irreversible, simplifying treatment decisions, and protecting vision long-term. Emphasis on early detection, risk assessment, and continuity of care. She is rated 5 stars across 1,500+ patient reviews on Google.

Eight Glaucoma Myths That Cost People Their Vision

MythWhat the Evidence Shows
Glaucoma only affects the elderly.While risk rises with age, glaucoma can occur at any age. Juvenile glaucoma affects teenagers. Primary open angle glaucoma is well documented in patients in their 30s and 40s, particularly in South Asian populations with high myopia or family history.
I would know if I had glaucoma — my vision is fine.Glaucoma destroys peripheral vision first. Central vision — what you use to read and recognise faces — is preserved until very late in the disease. The brain compensates for peripheral loss so effectively that patients can lose 40% of their optic nerve before noticing anything.
Glaucoma always causes high eye pressure.Normal tension glaucoma — where the optic nerve is damaged despite normal IOP — accounts for 30–40% of glaucoma in India. A normal pressure reading does not mean your optic nerve is safe.
Glaucoma means I will go blind.Glaucoma diagnosed and treated early is very unlikely to cause blindness. Most patients with well-managed glaucoma retain functional vision for life. The blindness associated with glaucoma is almost always the result of late detection or inadequate treatment.
Glaucoma treatment means surgery.The majority of glaucoma patients are managed with eye drops alone for many years. Laser procedures (SLT) are used when drops are insufficient or poorly tolerated. Surgery is reserved for cases where other treatments fail or where IOP needs to be lowered substantially.
Once I start glaucoma drops, I am on them forever.Treatment duration depends on the stage of disease, IOP response, and patient factors. Some patients transition from drops to laser. Some achieve adequate control with laser alone. Surgical treatment can reduce or eliminate drop dependence. Your specialist reviews this regularly.
Glaucoma runs in my family but I feel fine, so I must be fine.Family history of glaucoma increases your personal risk four to nine times. Feeling fine is expected — glaucoma is asymptomatic. A first-degree relative with glaucoma is the single strongest indication for annual specialist screening, regardless of how well you feel.
Glaucoma eye drops are just for reducing pressure — they have no other effect.Glaucoma drops significantly affect the eye surface, causing dry eye, redness, and allergic reactions in many patients. Some systemic drops affect heart rate and blood pressure. Your specialist needs to know your full medical history and all medications before prescribing.

Frequently Asked Questions

Is There a Cure for Glaucoma?

There is no cure for glaucoma in the sense of restoring damaged nerve tissue. The optic nerve fibres lost to glaucoma do not regenerate. Treatment halts or slows progression — it does not reverse what has already been lost. This is why early detection is the single most important determinant of outcome.

Can I Check My Own Eye Pressure at Home?

Home tonometers are available and improving, but they are not a substitute for specialist monitoring. IOP is one variable in glaucoma management. Optic nerve appearance, visual field status, and nerve fibre layer thickness are equally or more important — none of which a home device measures. Home monitoring may have a role as a supplement to specialist care, not a replacement for it.

How Often Do I Need to See a Glaucoma Specialist?

This depends on your disease stage and stability. Newly diagnosed or unstable patients are typically reviewed every three to four months. Stable patients with well-controlled IOP and no progression may be reviewed every six to twelve months. Your schedule is set by your specialist and should not be deferred because you feel well.

Does Glaucoma Affect Both Eyes Equally?

Glaucoma is often asymmetric — it begins in one eye before the other and progresses at different rates. This asymmetry is one reason patients do not notice it. The better eye compensates for the worse eye. By the time both eyes are significantly affected, the window for prevention has often closed in the first eye.

About the Author

This article was written by Dr Shibal Bhartiya, fellowship-trained glaucoma specialist and Mayo Clinic Research Collaborator, Clinical Director at Marengo Asia Hospitals, Gurugram, known for ethical, patient-centred glaucoma care and independent glaucoma second opinions. She is also the Program Director for Community Outreach & Wellness; and for the Marengo Asia International Institute of Neuro and Spine.

She has published peer-reviewed research on glaucoma management, examining how treatment decisions should balance medical evidence, patient preferences, and long-term vision outcomes.

As Editor-in-Chief of Clinical and Experimental Vision and Eye Research and Executive Editor of the Journal of Current Glaucoma Practice (Pubmed Indexed, official journal of the International Society of Glaucoma Surgery), Dr Shibal Bhartiya brings editorial and research depth to every clinical decision. Her 200+ publications, including 90+ PubMed-indexed publications and 28 edited textbooks span glaucoma biology, surgical outcomes, health equity, and emerging diagnostics.

1500+ Five Star Patient Reviews Google Business Profile

If you are unable to come to Dr Bhartiya’s clinic: Read more about teleconsultation for glaucoma

Read her research on PubMed | Google Scholar | ResearchGate | ORCID

Upload your reports for a structured review.| www.drshibalbhartiya.com | +91 88826 38735

Leave a review on Google

Related Reading
Get an Online Glaucoma Consult
Visual Field and OCT: Structure & Function Correlation
Glaucoma Diagnosis in Gurgaon
Risk Stratification in Glaucoma
Glaucoma Progression: What It Means and How to Slow It
Glaucoma treatment in Gurgaon
All About Glaucoma Medication
Glaucoma Lasers: SLT & LPI
Glaucoma surgery in Gurgaon
MIGS in Gurgaon
Get a Glaucoma Second Opinion in Gurgaon

Glaucoma and Dry Eye

Dry eye disease and glaucoma often occur together, especially because some glaucoma eye drops can affect the tear film and make symptoms like burning, irritation, watering, or fluctuating vision worse. Early diagnosis and treatment of both conditions can improve comfort and help protect long-term vision.

Glaucoma and dry eye disease occur together more often than chance alone explains. If your eyes burn, sting, or feel gritty while you are on glaucoma drops, you are not imagining it. This combination is common, clinically important, and often undertreated.

Dr Shibal Bhartiya is a fellowship-trained glaucoma specialist and Mayo Clinic Research Collaborator with over 25 years of experience. Her approach focuses on identifying risk before damage is irreversible, simplifying treatment decisions, and protecting vision long-term. Emphasis on early detection, risk assessment, and continuity of care. She is rated 5 stars across 1,500+ patient reviews on Google.


How Common Is Glaucoma and Dry Eye Overlap?

Studies consistently show that 40 to 60 percent of glaucoma patients meet diagnostic criteria for dry eye disease. The reverse is also true: people with moderate to severe dry eye carry a higher risk of developing glaucoma-related damage. These are not coincidental companions. They share biological mechanisms, and each condition can quietly worsen the other.


Why Does Dry Eye Develop in Glaucoma Patients?

The preservative problem

Most glaucoma eye drops contain benzalkonium chloride (BAK) as a preservative. BAK is effective at keeping the bottle sterile, but it is toxic to the cells of the ocular surface. It disrupts the tear film, damages goblet cells (the cells that produce the mucin layer of your tears), and triggers chronic inflammation.

Patients who use two or three glaucoma drops daily — each containing BAK — are exposing their eyes to this preservative four, six, or more times every day. Over months and years, the cumulative damage is significant. The conjunctiva becomes inflamed, the cornea loses its smooth optical surface, and the eyes feel perpetually uncomfortable.

This is not a rare side effect. It is an expected biological consequence of long-term BAK exposure, and it is one of the most underrecognised sources of glaucoma-related suffering.

Pre-existing risk

Dry eye disease is more common in the same demographic groups that develop glaucoma: older adults, women after menopause, and people with autoimmune conditions. Many patients arrive at a glaucoma diagnosis already carrying a degree of ocular surface disease. Adding BAK-containing drops to a compromised surface accelerates the damage.

Reduced blink rate

Glaucoma patients and patients with dry eye often share a common modern risk factor: prolonged screen use. Reduced blink rate during screen time is one of the fastest-growing contributors to evaporative dry eye, and it worsens the tolerance to topical medications.


Why Does This Overlap Matter Clinically?

Medication adherence

Dry eye makes glaucoma drops uncomfortable. Burning, stinging, and a sense of grittiness after instillation are among the most common reasons patients quietly reduce their drop frequency or stop altogether. This is rational behaviour in response to pain — but the result is uncontrolled intraocular pressure and silent glaucoma progression.

Treating dry eye is not a cosmetic afterthought. It is a strategy for protecting adherence, which protects the optic nerve.

Diagnostic accuracy

Dry eye causes variable intraocular pressure readings. Epithelial irregularity from a damaged ocular surface can affect tonometry (pressure measurement) and cause artificially high or variable readings. This creates noise in the data your glaucoma specialist depends on.

Similarly, a poor ocular surface causes artefacts in OCT scans and visual field tests. Blurring from unstable tear film produces dips and losses in visual field testing that mimic glaucoma progression. Distinguishing true nerve damage from tear-film artefact requires a clinician who is looking for both.

Quality of life

Glaucoma itself does not hurt and often produces no symptoms until late. But the treatment — the drops — can make patients miserable. Chronic ocular surface pain, light sensitivity, and fluctuating vision are quality-of-life burdens that patients often accept as inevitable. They are not inevitable.


How Do We Assess This in the Clinic?

A comprehensive evaluation for a glaucoma patient with ocular surface complaints includes:

  • Tear film assessment: Tear breakup time (TBUT) measures how quickly your tear film breaks apart after a blink. In dry eye, this is shortened.
  • Ocular surface staining: Fluorescein and lissamine green dyes reveal damaged cells on the cornea and conjunctiva.
  • Meibomian gland evaluation: Most dry eye in glaucoma patients is evaporative, caused by dysfunction of the oil-producing meibomian glands at the lid margins.
  • Symptom questionnaires: Validated tools like OSDI (Ocular Surface Disease Index) capture the patient experience beyond what the slit lamp shows.
  • Review of the current drop regimen: How many drops, which preservatives, how many times daily.

What Are the Management Options?

Switching to preservative-free formulations

This is often the single most impactful intervention. Preservative-free glaucoma drops deliver the same intraocular pressure-lowering effect without the chronic ocular surface toxicity. Multiple classes of glaucoma medication are now available in preservative-free formats: prostaglandin analogues, beta-blockers, carbonic anhydrase inhibitors, and fixed-dose combinations.

The transition requires some planning — not all formulations are available in preservative-free versions in every market, and cost is a factor — but for patients with documented ocular surface disease, this is a clinically justified switch that most guidelines now support.

Fixed-dose combination drops

Instead of using two bottles separately (each with its own preservative load), a fixed-dose combination delivers two active ingredients in one drop. This halves the number of preservative exposures per day. For patients who genuinely need two active agents, this is a practical step even before moving to preservative-free options.

Treating the dry eye directly

Ocular surface disease responds to targeted treatment. The approach depends on the type and severity:

  • Artificial tears: Lubricating drops, preferably preservative-free, used consistently throughout the day. These dilute residual BAK, stabilise the tear film, and reduce surface friction.
  • Warm compresses and lid hygiene: For meibomian gland dysfunction, daily warm compress application followed by gentle lid massage improves the quality of the oily tear layer.
  • Omega-3 supplementation: Good evidence supports dietary omega-3 fatty acids for meibomian gland function and tear quality.
  • Anti-inflammatory therapy: Topical cyclosporine (Restasis, Ikervis) or lifitegrast addresses the inflammatory cycle that perpetuates chronic dry eye. In patients with significant ocular surface inflammation, this can be transformative.
  • Punctal plugs: Small silicone plugs inserted into the tear drainage points slow the drainage of natural tears, keeping the eye surface better hydrated.

Laser and surgical IOP control

For some patients, reducing or eliminating the need for topical drops altogether is the right goal. Selective laser trabeculoplasty (SLT) can lower IOP without any drops. For more advanced glaucoma, surgical options including minimally invasive glaucoma surgery (MIGS) and trabeculectomy may reduce drop burden significantly. When a patient’s ocular surface is severely compromised by long-term drop use, a surgical discussion is worth having.


A Note on Sequence and Timing

When a patient presents with both conditions, the sequence of assessment matters. Dry eye can artificially distort IOP readings and OCT quality. I prefer to stabilise the ocular surface first — or at least treat both simultaneously — so that subsequent glaucoma monitoring data is reliable. A visual field test performed through an unstable tear film is not a trustworthy test.


What Should You Tell Your Doctor?

If you are being treated for glaucoma and your eyes feel uncomfortable, please say so explicitly. Many patients assume irritation is part of the package and do not raise it. Your doctor needs to know:

  • Which symptoms bother you most (burning, grittiness, blurred vision, light sensitivity)
  • Whether symptoms are worse at certain times of day or after drop instillation
  • Whether you have ever reduced or skipped your drops because of discomfort
  • Whether you use a screen for extended hours daily

This information changes the clinical approach. It does not make you a difficult patient — it makes your care more precise.


Frequently Asked Questions

Can glaucoma drops cause dry eye?

Yes. Most glaucoma drops contain benzalkonium chloride, a preservative that damages the ocular surface over time. Long-term exposure causes inflammation, goblet cell loss, and dry eye disease. Switching to preservative-free formulations often brings significant relief.

Do I have to choose between treating my glaucoma and treating my dry eye?

No. Both conditions can and should be managed simultaneously. In many cases, treating dry eye actively improves the tolerability of glaucoma drops and supports adherence to treatment, which protects the optic nerve.

Are preservative-free glaucoma drops as effective as regular drops?

Yes. The active ingredient is the same. The preservative is only there to keep the bottle sterile between uses. Preservative-free formulations use single-dose units instead, delivering the same intraocular pressure-lowering effect without the surface toxicity.

Can dry eye affect my glaucoma test results?

Yes. An unstable tear film causes variable IOP readings and artefacts in visual field and OCT testing. This is one reason a thorough ocular surface assessment is part of comprehensive glaucoma care.

I use three different glaucoma drops. Is that a problem for my eyes?

Three separate bottles often means three doses of BAK per application. This is a significant preservative load. A conversation about fixed-dose combinations or preservative-free alternatives is worth having with your glaucoma specialist.

Is laser treatment an option if my eyes cannot tolerate drops?

Yes. Selective laser trabeculoplasty (SLT) can lower IOP and reduce dependence on drops. For patients whose ocular surface disease is severe and driven by drop toxicity, reducing the drop burden through laser or surgery is a clinically sound strategy.


Internal Linking Architecture Statement

This page is part of the Glaucoma Hub hub. Read about our full approach to glaucoma diagnosis, monitoring, and treatment. Please also read our Dry Eye Hub. Here’s another heartening patient story: Tired of glaucoma eyedrops.


About the Author

This article was written by Dr Shibal Bhartiya, fellowship-trained glaucoma specialist and Mayo Clinic Research Collaborator, Clinical Director at Marengo Asia Hospitals, Gurugram, known for ethical, patient-centred glaucoma care and independent glaucoma second opinions. She is also the Program Director for Community Outreach & Wellness; and for the Marengo Asia International Institute of Neuro and Spine.

She has published peer-reviewed research on glaucoma management, examining how treatment decisions should balance medical evidence, patient preferences, and long-term vision outcomes.

As Editor-in-Chief of Clinical and Experimental Vision and Eye Research and Executive Editor of the Journal of Current Glaucoma Practice (Pubmed Indexed, official journal of the International Society of Glaucoma Surgery), Dr Shibal Bhartiya brings editorial and research depth to every clinical decision. Her 200+ publications, including 90+ PubMed-indexed publications and 28 edited textbooks span glaucoma biology, surgical outcomes, health equity, and emerging diagnostics.

1500+ Five Star Patient Reviews Google Business Profile

If you are unable to come to Dr Bhartiya’s clinic: Read more about teleconsultation

Read her research on PubMed | Google Scholar | ResearchGate | ORCID

Upload your reports for a structured review.| www.drshibalbhartiya.com | +91 88826 38735

Leave a review on Google


Read More

Basics of Dry Eye, Dry Eye Second Opinion, Dry Eye: A Chronic Disease

Why Do Women Get Dry Eye More Often? Menopause and Dry Eye

Dry Eyes: Natural Remedies, Dry Eyes: Tips to Soothe Sore Eyes

Why Dry Eye Is Worse in Air Conditioning and on Flights

Screen Fatigue, Why Vision Becomes Blurred After Reading or Screen Use,

Why Your Eyes Water Constantly, Omega-3 and Dry Eye, Why Are Your Dry Eye Drops Not Working

Glaucoma Eye Drops: The Complete Guide, Laser or Eye Drops for Glaucoma

Managing Glaucoma Eye Drop Side Effects, Which Is the Best Eyedrop for Glaucoma?

Why Do I Need So Many Glaucoma Eye Drops?

HOW TO DO VISUAL FIELD

A visual field test checks your side (peripheral) vision and helps detect or monitor glaucoma and other optic nerve conditions. During the test, you look straight ahead and press a button whenever you notice lights appearing in different parts of your vision.

Automated static perimetry is the clinical gold standard for tracking glaucoma progression. Yet it is notoriously anxiety-inducing. High fixation losses and false positives corrupt diagnostic data when a patient is stressed. Active coaching before and during the test stabilises fixation, yields clean reproducible data, and transforms a feared exam into a collaborative clinical tool.

Dr Shibal Bhartiya is a fellowship-trained glaucoma specialist and Mayo Clinic Research Collaborator with over 25 years of experience. Her approach focuses on identifying risk before damage is irreversible, simplifying treatment decisions, and protecting vision long-term. Emphasis on early detection, risk assessment, and continuity of care. She is rated 5 stars across 1,500+ patient reviews on Google.


How Patient-First Coaching Transforms Glaucoma Perimetry

Ask any glaucoma patient what part of their routine checkup they dread most. Nine out of ten will say the visual field test.

Sitting alone in a dark room, staring at a central yellow light, clicking a button for faint flashes you think you might be missing — it feels less like a diagnostic test and more like a high-stakes exam you are destined to fail.

A patient recently left a review that captured exactly why we approach this differently. They noted how other clinics seat you in the machine and tell you to press the clicker. No explanation. No preparation. Just anxiety and confusion. They described how, in our clinic, the entire experience was different. We walked them through what the visual field map actually shows. We explained the rhythm of the test before they started. They felt like a partner in their own care — not a passive subject.

You can read their experience here on Google.

When a patient understands that missing some flashes is a normal part of the machine’s threshold calculation, their heart rate drops. Their blinking stabilises. Their anxiety disappears.

That extra ten minutes of human coaching does not just produce a more comfortable patient. It produces pristine, accurate diagnostic data — the data we rely on to protect their optic nerve for decades.

What Actually Happens During a Visual Field Test

You sit with one eye covered and rest your chin on the machine. Your job is simple: keep looking at the central target and press the button whenever you notice a light anywhere in your side vision.

You are not expected to see every flash.

In fact, the machine deliberately presents lights that become increasingly faint to identify the threshold where vision transitions from “seen” to “not seen.” Missing some lights is not failure — it is how the test works.

Blink normally. Take short pauses if needed. If your attention drifts for a moment, do not panic and start clicking rapidly to catch up. The best visual field tests are usually not the fastest tests. They are the calmest.


The Most Common Mistake Patients Make

Patients often believe this is an intelligence test or a reaction-time test.

It is neither.

Trying too hard can sometimes reduce accuracy. Clicking every time you think a light might have appeared creates false positives. Chasing missed flashes leads to fatigue and fixation loss.

The goal is not perfection. The goal is honest responses.


Why One Visual Field Rarely Tells the Whole Story

A visual field is not interpreted in isolation.

Sleep, dry eye, anxiety, distraction, cataract, learning the machine, and even understanding instructions can influence a result.

That is why glaucoma decisions are usually made by combining visual fields with optic nerve examination, eye pressure, imaging, and change over time.

Protecting vision is rarely about one dramatic test result. It is about recognising patterns early and responding before change becomes irreversible.


FAQs

How do I prepare for a visual field test?

No special preparation is usually needed. Wear your glasses if advised, stay relaxed, and try to rest your eyes before the test.

Is a visual field test painful?

No. A visual field test is non-contact, painless, and usually takes only a few minutes for each eye.

Why do visual field tests need to be repeated?

Visual field tests help monitor change over time. In glaucoma, repeated tests are often more useful than a single result because they help detect progression early.

Why is the visual field test for glaucoma so stressful?

The test is designed to find the absolute limit of your peripheral vision. It presents flashes that are intentionally very faint, so feeling like you are missing lights or guessing is completely normal. This design triggers anxiety when the process is not explained beforehand. Preparation changes the entire experience.

How does anxiety affect the accuracy of a glaucoma perimetry test?

High anxiety leads to irregular blinking, rapid head movements, and false-positive clicking. These introduce significant noise into the results. An ophthalmologist cannot reliably distinguish true disease progression from a stressful test day. A coached, relaxed patient produces far more clinically reliable data.

What if I think I did badly on my visual field test?

Many patients feel they performed poorly, especially during early tests. A difficult test does not automatically mean glaucoma has worsened. Ophthalmologists interpret reliability measures, compare previous results, and look for repeatable patterns over time.

Am I Doing My Visual Field Test Wrong?

Most patients worry they are doing badly because they miss flashes or feel uncertain during the test. That feeling is normal. Visual field testing is designed to find the edge of what you can see, so missing lights is expected and does not mean you have failed.

Why Do I Keep Missing Lights on My Glaucoma Test?

The machine deliberately shows lights that become fainter and fainter to calculate your visual threshold. Missing some lights helps the test work properly. Trying to click for every possible flash often makes results less reliable than staying relaxed and responding naturally.


This page is part of the Advanced Glaucoma Care hub. Read about the full spectrum of glaucoma diagnosis and treatment.


About the Author

This article was written by Dr Shibal Bhartiya, fellowship-trained glaucoma specialist and Mayo Clinic Research Collaborator, Clinical Director at Marengo Asia Hospitals, Gurugram, known for ethical, patient-centred glaucoma care and independent glaucoma second opinions. She is also the Program Director for Community Outreach & Wellness; and for the Marengo Asia International Institute of Neuro and Spine.

She has published peer-reviewed research on glaucoma management, examining how treatment decisions should balance medical evidence, patient preferences, and long-term vision outcomes.

As Editor-in-Chief of Clinical and Experimental Vision and Eye Research and Executive Editor of the Journal of Current Glaucoma Practice (Pubmed Indexed, official journal of the International Society of Glaucoma Surgery), Dr Shibal Bhartiya brings editorial and research depth to every clinical decision. Her 200+ publications, including 90+ PubMed-indexed publications and 28 edited textbooks span glaucoma biology, surgical outcomes, health equity, and emerging diagnostics.

1500+ Five Star Patient Reviews Google Business Profile

If you are unable to come to Dr Bhartiya’s clinic: Read more about teleconsultation

Read her research on PubMed | Google Scholar | ResearchGate | ORCID

Upload your reports for a structured review.| www.drshibalbhartiya.com | +91 88826 38735

Leave a review on Google


Uveitic Glaucoma: Rebuilding Futures

Uveitic glaucoma is a form of glaucoma caused by eye inflammation, where pressure damage and inflammation can both threaten vision. Treatment often needs to control not just eye pressure—but also the underlying inflammation and long-term risk of optic nerve damage.

Uveitic glaucoma is one of the most complex secondary glaucomas. Chronic intraocular inflammation alters the eye’s natural drainage pathways, and standard surgical interventions — including multiple trabeculectomies and tube shunts — frequently fail. When all conventional options are exhausted, management pivots to aggressive inflammatory control and microscopic pressure regulation. For young professionals navigating severe visual field constriction, preserving the remaining central island of vision requires clinical precision alongside genuine human investment.

Dr Shibal Bhartiya is a fellowship-trained glaucoma specialist and Mayo Clinic Research Collaborator with over 25 years of experience. Her approach focuses on identifying risk before damage is irreversible, simplifying treatment decisions, and protecting vision long-term. Emphasis on early detection, risk assessment, and continuity of care. She is rated 5 stars across 1,500+ patient reviews on Google.


Protecting Sight and Rebuilding Futures in Advanced Uveitic Glaucoma

In the most advanced stages of glaucoma, we are no longer fighting a disease in isolation. We are fighting for millimetres of survival.

He came to me in his early 30s — a brilliant young computer engineer carrying an almost unbearable clinical history. He had aggressive uveitic glaucoma, a secondary glaucoma born from chronic internal eye inflammation. One eye had already lost all light perception. In his remaining eye, his visual field was severely constricted. He was navigating the world and his entire career through a narrow, precious tunnel of sight.

He had already endured six complex surgeries elsewhere: three failed trabeculectomies and two failed tube shunts. After multiple attacks of uveitis, he had come to me. I started him on biologics, under the supervision of a rheumatologist, and the infalmaation was controlled.

His glaucoma surgery is failing, and he needs additional anti glaucoma medication to control his eye pressures, but he is bright and cheerful. And very compliant with his medication.

When a young patient is down to their final island of vision, the clinical tightrope is extraordinarily narrow. While he was in our clinic updating his visual field mapping so we could calibrate his pressure and inflammation management, something unexpected happened.

The Light At The End Of The Tunnel

Sitting just outside the diagnostic room was another long-term patient of mine — a gentleman I have monitored as a glaucoma suspect for nearly ten years. His optic discs are highly suspicious. His family history is significant. Through meticulous tracking, we have kept him stable without aggressive treatment. In his professional life, he is the Founder of a serious tech company.

I walked over and asked him a simple question: “Are you going to help one of my glaucoma boys?”

He did not hesitate. I introduced them right there in the clinic corridor. The CEO looked at him and said: “I cannot hand you a job. But I can give you an interview.”

My boy took that single opportunity and ran with it. He walked into a high-stakes technical interview, demonstrated his mastery of JavaScript and Python — the exact languages their infrastructure required — and cleared it entirely on his own merit.

Today, he is a working engineer at the global firm.

Medicine, at its truest, is not just about the eye in front of you. It is about the life behind it.

Lesson Learnt

Uveitic glaucoma is not simply high eye pressure with inflammation—it is often a balancing act between controlling inflammation and protecting the optic nerve. Eye pressure may rise because of inflammation itself, steroid treatment, or damage to the eye’s drainage system, and vision can feel unpredictably better or worse over time.

Treatment is usually more than adding drops and may require careful adjustment of anti-inflammatory treatment, glaucoma medications, or systemic therapy. Surgery can be more complex than routine glaucoma surgery because inflamed eyes may scar, heal differently, and need the eye to be quiet before intervention whenever possible. Long-term outcomes often depend not only on lowering pressure, but on maintaining calm, stable control of inflammation over time.


FAQs

What is uveitic glaucoma?

Uveitic glaucoma is glaucoma that develops because of eye inflammation (uveitis) and/or its treatment. Both inflammation and raised eye pressure can contribute to vision loss if not managed carefully.

What are biologics and when are they used in uveitis?

Biologics are targeted medicines used to control inflammation when uveitis is severe, recurrent, or not responding well to standard treatment. They may help reduce repeated inflammation and protect long-term vision.

Can biologics help reduce glaucoma risk in uveitis?

Controlling inflammation early and consistently may reduce the pressure fluctuations, steroid exposure, and structural damage that contribute to uveitic glaucoma.

Are biologics used instead of glaucoma treatment?

No. Biologics manage the inflammatory part of the disease. Eye pressure control, glaucoma monitoring, medicines, laser, or surgery may still be needed depending on the individual situation.

What makes uveitic glaucoma harder to treat than primary open-angle glaucoma?

Uveitic glaucoma is driven by active, recurrent intraocular inflammation. Inflammatory debris and scar tissue physically block the trabecular meshwork. Because the tissue is inherently inflamed, surgical options like trabeculectomies and tube shunts carry a significantly higher risk of scarring over and failing. A specialist must constantly balance anti-inflammatory therapy with pressure control.

Can a computer engineer or programmer work effectively with severe tunnel vision?

Yes. Patients with constricted visual fields retain their central visual acuity — the ability to see fine detail directly in front of them. With high-contrast coding environments, screen magnification, tailored monitor positioning, and regular clinical monitoring to prevent further field loss, highly technical professionals can continue to excel in demanding engineering roles.


This page is part of the Advanced Glaucoma Care hub. Read about the full spectrum of glaucoma diagnosis and treatment. Please also read about Glaucoma Surgery in Gurgaon, and Steroid Induced Glaucoma.


About the Author

This article was written by Dr Shibal Bhartiya, fellowship-trained glaucoma specialist and Mayo Clinic Research Collaborator, Clinical Director at Marengo Asia Hospitals, Gurugram, known for ethical, patient-centred glaucoma care and independent glaucoma second opinions. She is also the Program Director for Community Outreach & Wellness; and for the Marengo Asia International Institute of Neuro and Spine.

She has published peer-reviewed research on glaucoma management, examining how treatment decisions should balance medical evidence, patient preferences, and long-term vision outcomes.

As Editor-in-Chief of Clinical and Experimental Vision and Eye Research and Executive Editor of the Journal of Current Glaucoma Practice (Pubmed Indexed, official journal of the International Society of Glaucoma Surgery), Dr Shibal Bhartiya brings editorial and research depth to every clinical decision. Her 200+ publications, including 90+ PubMed-indexed publications and 28 edited textbooks span glaucoma biology, surgical outcomes, health equity, and emerging diagnostics.

1500+ Five Star Patient Reviews Google Business Profile

If you are unable to come to Dr Bhartiya’s clinic: Read more about teleconsultation

Read her research on PubMed | Google Scholar | ResearchGate | ORCID

Upload your reports for a structured review.| www.drshibalbhartiya.com | +91 88826 38735

Leave a review on Google