Glaucoma Treatment in Gurgaon: Eye drops, Laser and Surgery Explained by Dr Shibal Bhartiya, a fellowship trained glaucoma specialist.

Glaucoma treatment is not one-size-fits-all. The right treatment depends on your glaucoma type, your optic nerve health, your age, your lifestyle, and how fast your disease is progressing. The goal is never just to lower a number, it is to protect the optic nerve over the long arc of your life. This page explains all three treatment options: eye drops, laser, and surgery.

Glaucoma is a chronic disease. It cannot be cured, but it can be controlled. With the right glaucoma treatment, most patients keep their vision for life. This page explains the three main glaucoma treatment options: eye drops, laser procedures, and surgery.

It answers the questions patients most commonly ask about each. If you have been recently diagnosed, or if you are reviewing your current treatment plan, this guide will help you understand your options and what to expect.

Dr Shibal Bhartiya is a fellowship-trained glaucoma specialist in Gurgaon with expertise in all three treatment modalities, including minimally invasive glaucoma surgery (MIGS). If you have questions about your specific situation, a structured consultation or second opinion can bring clarity.

Q1. I have glaucoma. What are my treatment options?

Your doctor will first perform a test called gonioscopy to determine your glaucoma subtype: open angle or closed angle. This guides all treatment decisions.

For open-angle glaucoma, treatment usually starts with eye drops to lower eye pressure. Your doctor will monitor their effect over time and adjust as needed. A laser procedure called selective laser trabeculoplasty (SLT) may also be offered, either as a first-line treatment or alongside drops.

For closed-angle glaucoma, a laser procedure called laser peripheral iridotomy (LPI) is the first step. It creates an alternative drainage channel in the iris. Eye drops may be added after.

If drops and laser do not achieve adequate pressure control, particularly in advanced glaucoma or complex subtypes, surgery is recommended. Options include trabeculectomy, minimally invasive glaucoma surgery (MIGS), and tube shunt implants such as the Ahmed Glaucoma Valve.

— Eye Drops —

Q2. What are the common glaucoma medications?

The table below lists the most commonly used glaucoma eye drops. This is not an exhaustive list. Your doctor will prescribe what is most appropriate for your eye pressure, general health, and lifestyle, and customise your glaucoma treatment to best preserve your vision long term.

Q3. My eye pressure is normal after medication. Do I still need to take my drops?

Yes, always. Your eye pressure is normal because the drops are working. If you stop, the pressure will rise again within days.

Think of glaucoma like high blood pressure or diabetes. Medication controls the condition; it does not cure it. Stopping glaucoma treatment puts your vision at risk.

Important to Understand: What is my target eye pressure?

Target IOP is the pressure level that will keep your specific optic nerve stable over your lifetime. It is not the same for every patient. Someone with early glaucoma and a healthy nerve may have a target of 18 mmHg. Someone with advanced damage may need a target below 12. Your target is set based on your optic nerve, your rate of progression, your age, and your individual risk. It changes over time as new information comes in

Q4. Can I switch to a generic medicine?

Generic eye drops contain the same active ingredient at the same concentration, and are chemically equivalent to branded products. In most cases, they are appropriate to use.

However, equivalence in eye drops is harder to guarantee than with tablets, because blood levels cannot be monitored. Small differences in preservatives, drop size, or packaging can affect how well the drop is absorbed and how comfortable it feels.

Discuss any switch with your doctor. If your eye pressures remain stable and the drop is comfortable, a generic may be a reasonable, cost-effective option for glaucoma treatment.

Q5. What are the side effects of glaucoma eye drops?

Almost all glaucoma drops can cause some eye dryness or local irritation. Allergic reactions are possible with any medication. Specific side effects by drug class include:

• Prostaglandin Analogues: Darkening of iris or eyelid skin (especially with light eyes), redness, stinging, blurred vision, growth of eyelashes.
• Beta Blockers: Slowed pulse, fatigue, shortness of breath (particularly in asthma patients), reduced libido, low mood.
• Alpha Agonists: Stinging, fatigue, headache, drowsiness, dry mouth and nose.
• Carbonic Anhydrase Inhibitors (eye drop): Stinging, altered taste.
• Carbonic Anhydrase Inhibitors (oral tablet): Tingling in hands and feet, stomach upset, confusion, low mood, metabolic imbalances.

Note: Preservative Free Glaucoma Eye drops

Most standard glaucoma drops contain a preservative called BAK (benzalkonium chloride). BAK keeps the bottle sterile, but it also irritates the surface of the eye. Used daily for years, it can cause chronic dry eye, redness, and a condition called ocular surface disease.

This matters more than most patients realise. If your eyes are constantly irritated, you are less likely to use your drops consistently. And inconsistent drops mean uncontrolled pressure.

Preservative-free formulations of most common glaucoma medications now exist, including prostaglandins, beta blockers, and fixed combinations. They cost more, but for patients on long-term treatment, or those already prone to dry eye, they are often the right choice.

If your eyes feel persistently dry, red, or irritated on your current drops, tell your doctor. It may not be the medication itself, it may be the preservative. Switching formulation is a simple change that can make a significant difference to both comfort and adherence.

📌 Always tell your doctor if you experience new symptoms. Many side effects can be managed by switching to a different class of drop. A second opinion may help if you are struggling.

If you would like a structured glaucoma risk assessment or second opinion about ocular discomfort and side effects of glaucoma eye drops, you can contact my coordinator for a time slot at+91 88826 38735

Q6. How do I put in my eye drops correctly?

Follow your doctor’s instructions on dose and timing. These steps help ensure the drop reaches the eye and stays in:

• Wash your hands before you begin.
• Tilt your head back while seated, or lie down.
• Gently pull your lower lid down with one finger to form a small pocket.
• Look up and squeeze one drop into the pocket. Avoid touching the dropper tip to your eye or hand.
• Close your eyes for two minutes. Press gently on the inner corner of the closed eye with your fingertip, this reduces absorption into the bloodstream.
• If you use more than one type of drop, wait five minutes between each.
• Blot any excess from around the eye with a clean tissue.

📌 If your hands shake, rest your hand against your face and approach from the side. If arthritis makes squeezing difficult, ask your doctor about a bottle-squeezing assistive device.

Q7. I keep forgetting to take my eye drops. What can I do?

You are not alone. Adherence is one of the biggest challenges in glaucoma treatment. Missed drops mean higher pressure and faster disease progression.

Practical strategies that help:

• Set a recurring alarm on your phone and act on it immediately.
• Keep your drops on your bedside table and link them to a fixed habit, such as removing your glasses at bedtime. (Note: Xalatan requires refrigeration until opened, after which it can be stored at room temperature.)
• Download an eye drop reminder app, search ‘eye drop reminder’ on the App Store or Google Play.
• Ask a family member to remind you, or help you track your drops.
• Use the same system for scheduling your doctor appointments, a shared calendar or phone reminder works well.

— Laser Treatment —

Q8. I have been advised laser iridotomy. What is that?

A laser peripheral iridotomy (LPI) is used to treat or prevent closed-angle glaucoma. The laser creates a tiny opening in the iris, allowing fluid to flow more freely within the eye and preventing dangerous pressure spikes.

Before the procedure, your doctor will instil drops to make your pupil smaller. A local anaesthetic drop is then applied so you feel no pain. A small lens is placed on your eye to improve visibility, and you are asked to look at a red light while the laser is applied.

Most patients experience mild discomfort, but the procedure is brief. Vision may be blurred for up to three days after. Your doctor will usually prescribe steroid drops for about a week.

Q9. I have been advised selective laser trabeculoplasty (SLT). What is that?

SLT is used for open-angle glaucoma. A low-energy laser is applied to the drainage angle of the eye. This stimulates the body’s own immune response to improve fluid outflow and lower eye pressure.

Before the procedure, drops are instilled to constrict the pupil and an eye pressure-lowering agent is given about an hour beforehand. A local anaesthetic drop is applied just before the procedure. You will sit at the laser machine with your face in a chin rest, and a contact lens is placed on the eye, as in a gonioscopy. You may feel a brief twinge or sting as the laser is applied.

Afterwards, you will use anti-inflammatory drops for up to a week. Continue all glaucoma medications as before unless told otherwise. Eye pressure is checked an hour after the procedure and again at one week.

📌 SLT takes one to three months to reach peak effect and may be temporary. Continued follow-up is essential. SLT can often be repeated if the effect wears off.

— Surgery —

Q10. What is trabeculectomy? Why might I need it?

Trabeculectomy is the most established glaucoma surgery. It is recommended when eye drops and laser have not adequately controlled your eye pressure, or when glaucoma is advanced at the time of diagnosis.

The surgeon creates a small flap in the white of the eye (sclera) through which fluid can drain out, collecting under the conjunctiva as a small elevation called a bleb. You may be able to see the bleb under your upper eyelid if you look in a mirror.

Trabeculectomy is highly effective in reducing eye pressure, and is the gold standard for surgical glaucoma treatment. It does carry risks, which your doctor will discuss with you before the procedure.

Q11. What is minimally invasive glaucoma surgery (MIGS)?

MIGS is a newer category of glaucoma surgery designed to lower eye pressure with less disruption to the eye than traditional surgery. It is often performed at the same time as cataract surgery.

MIGS procedures include devices such as iStent, Hydrus Microstent, and PRESERFLO MicroShunt. They work by improving drainage through the eye’s natural channels, or by creating a new drainage pathway with less tissue disruption.

MIGS is typically suitable for mild to moderate glaucoma where drops are insufficient or poorly tolerated. It carries a lower risk of complications than trabeculectomy but may produce a more modest pressure reduction.

Dr Shibal Bhartiya offers MIGS as part of a comprehensive glaucoma treatment strategy. If you would like to know whether MIGS is suitable for you, a second opinion consultation can help clarify your options.

Q12. What is an Ahmed Glaucoma Valve?

An Ahmed Glaucoma Valve (AGV) is a small silicone drainage implant placed in the eye to allow fluid to drain to a reservoir under the conjunctiva. It is a type of tube shunt surgery.

Your doctor may also place a small piece of donor sclera (white of the eye) to cover the tube and prevent it from working its way out.

Q13. Why am I getting an Ahmed Valve rather than a trabeculectomy?

Both procedures are proven to be equally effective and safe in the long term. Your doctor will recommend the best option based on your individual history.

An Ahmed Valve is often preferred in the following situations:

• Previous failed trabeculectomy: a repeat trabeculectomy has a lower chance of success.
• Certain complex glaucoma subtypes, including inflammatory, neovascular, and post-vitreoretinal surgery glaucomas, or cases with scarred corneas.
• Your doctor may reserve the Valve as a second-line procedure because of its higher cost.

Q14. What will I feel during surgery?

Most glaucoma surgeries are performed under local anaesthesia. You will receive an injection around the eye to numb it completely, and an intravenous medication to lower eye pressure before the procedure begins.

You will lie on your back. The area around your eye is cleaned, and a sterile drape is placed over your face. If you feel claustrophobic or are asthmatic, tell your anaesthetist in advance, oxygen can be delivered under the drape.

A small clip keeps the eyelid open so you do not need to worry about blinking. You will see the bright light of the surgical microscope. Your vision will blur as the surgery progresses.

You may feel some pressure or tugging, but surgery is largely painless. Most patients report that the anticipation is worse than the procedure itself. The operation typically takes 45 to 60 minutes. You should be back with family within a couple of hours.

Q15. What is the recovery period like?

Most patients experience a temporary drop in central vision immediately after surgery. This usually recovers within a few weeks. A change in your glasses prescription is common and will be assessed once the eye has stabilised.

Your doctor will see you the day after surgery. You will likely wear an eye patch overnight and have it removed the next morning. Follow-up visits are more frequent in the first few weeks, then become less so as your eye stabilises.

You will be prescribed antibiotic and steroid drops. Some of your glaucoma medications may be continued during the early post-operative period.

Q16. Do I need to restrict activity after surgery?

Gentle walking is encouraged soon after surgery, your doctor will recommend it. For the first week, wear an eye shield at night to protect the eye.

• Return to desk work: approximately two weeks.
• Strenuous exercise or weight lifting: avoid for at least one month.
• Swimming: avoid for at least one month.

📌 Always follow your surgeon’s specific instructions. Recovery timelines can vary depending on the type of surgery and how your eye responds.

Q17. What are the risks of glaucoma surgery?

Your doctor has weighed the risks against the risk of untreated glaucoma progression before recommending surgery. The main risks to be aware of include:

• Temporary vision drop: Reduced central vision in the early post-operative period due to inflammation, pressure fluctuations, or bleeding. This usually resolves within weeks.
• Cataract: The risk of cataract development increases after glaucoma surgery, and pre-existing cataract may progress faster.
• Infection: As with any surgery, there is an increased risk of infection. With trabeculectomy, this risk remains elevated long-term due to the presence of the bleb.
• Need for additional procedures: A further procedure or surgery may be needed to optimise pressure control.

📌 Knowing the risks allows you to monitor for early signs and report them promptly. Most complications are manageable when caught early.

If you would like a structured glaucoma risk assessment or second opinion:

+91 88826 38735
drshibalbhartiya.com

Upload your reports for a structured review.

Read the research articles

This article has been written by Dr Shibal Bhartiya, a glaucoma specialist in Gurgaon known for ethical, patient-centred glaucoma care and independent glaucoma second opinions. She is also a research collaborator with Mayo Clinic, Jacksonville, Florida, USA.

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

These peer-reviewed article discussing glaucoma treatment are benchmarks for glaucoma surgeons globally, and can be accessed on PubMed and Google Scholar

If you would like a structured glaucoma risk assessment or second opinion:

+91 88826 38735
drshibalbhartiya.com

Upload your reports for a structured review.