Glaucoma (Eye Pressure)
Medical and surgical treatment of glaucoma by Dr. Nejmi Öztürk, ophthalmologist and eye surgeon, at HG Hospital in Kahramanmaraş, Türkiye — eye drops, laser and glaucoma surgery
- Glaucoma (eye pressure) is silent damage to the optic nerve, usually caused by high pressure inside the eye; vision that is lost does not come back.
- Eye pressure is usually between 10 and 21 mmHg; but glaucoma can also occur at normal pressure, so the diagnosis is not based on the pressure reading alone.
- The treatment steps are drops, laser and surgery (trabeculectomy, tube, MIGS); using the drops regularly and keeping follow-up appointments protects your vision.
- The medical and surgical treatment of glaucoma at HG Hospital in Kahramanmaraş is performed by Dr. Nejmi Öztürk; SGK and insurance coverage is clarified at the examination.
What is glaucoma (eye pressure)?
Glaucoma (often called “eye pressure” or “high eye pressure”) is a group of diseases in which the optic nerve, which carries images from the eye to the brain, is permanently damaged. The most important cause is pressure inside the eye that is higher than the nerve can tolerate. A fluid is produced continuously inside the eye; it drains away through a sieve-like angle at the front of the eye. If the drainage slows down, the pressure rises and the nerve fibers slowly die. Because nerve fibers do not regenerate, the part of the visual field that is lost does not come back.
Glaucoma is called the “silent thief of sight” because the most common type causes no pain and the loss begins in the peripheral (side) vision. Since central vision remains good, the patient does not notice the loss. By the time it is noticed, a large part of the nerve may already be damaged. That is why a regular eye pressure measurement and an optic nerve examination are recommended after the age of 40.
What should eye pressure be?
In most people the pressure inside the eye is between 10 and 21 mmHg. But being in this range does not rule glaucoma in or out: in some people a pressure above 21 does not damage the nerve (ocular hypertension), while in others nerve damage develops at “normal” values such as 15–16 mmHg (normal-tension glaucoma). Corneal thickness also affects the reading: in a thin cornea the pressure measures lower than it really is, and in a thick cornea higher. That is why the diagnosis rests on the pressure value together with the appearance of the optic nerve head, the thickness of the nerve fiber layer and the visual field results. A separate “target pressure” is set for each patient.
What are the types of glaucoma?
- Open-angle glaucoma: The most common type. The drainage angle looks open, but the fluid does not drain well enough; the pressure rises slowly and causes no symptoms.
- Angle-closure glaucoma: The iris blocks the drainage angle. A sudden closure leads to an “acute glaucoma attack”: severe eye pain, headache, nausea, rings around lights and sudden blurring. This is an emergency. Chronic angle closure, on the other hand, can progress silently.
- Normal-tension glaucoma: Nerve damage progresses even though the pressure is within the normal range; low blood pressure, migraine and circulation problems may accompany it.
- Secondary glaucomas: Pseudoexfoliation (a dandruff-like material deposited in the eye; common in Türkiye), pigment dispersion, long-term steroid (cortisone) use, eye injury, uveitis, and neovascular glaucoma caused by advanced diabetic retinopathy.
- Congenital glaucoma: In babies it shows itself with large eyes, watering and discomfort in light; it requires surgery.
What are the symptoms of glaucoma, and who is at risk?
In its early stage, open-angle glaucoma has no symptoms; as the disease progresses, gaps that are hard to notice develop in the peripheral vision. The following symptoms suggest an advanced stage or the angle-closure type:
- Not noticing objects to the side; difficulty going down stairs and driving
- In the advanced stage, tunnel vision and reduced central vision
- Seeing colored rings (halos) around lights, eye ache and blurring in the evenings (angle closure)
- Sudden severe eye pain, redness, headache and nausea (acute attack; urgent care is needed)
- In some patients, no symptoms at all
Who is glaucoma screening suitable for?
- Everyone over 40 (every 2–4 years; over 60, every 1–2 years)
- People with glaucoma in the family (mother, father, sibling): the risk increases several-fold; screening starts earlier.
- People whose eye pressure has measured high and people with thin corneas
- People with high myopia (open angle) and people with high hyperopia (angle closure)
- People with diabetes, long-term users of cortisone (drops, sprays, tablets), and people who have had an eye injury
- People with migraine, low blood pressure or sleep apnea (in terms of normal-tension glaucoma)
Who is it not suitable for?
- Prostaglandin-type drops are chosen with care in patients with active inflammation inside the eye or macular edema.
- Beta-blocker drops are not used in people with asthma, COPD, a slow heartbeat or heart block.
- Carbonic anhydrase inhibitor tablets may not be suitable for people with a sulfonamide allergy or a history of kidney stones.
- SLT laser is not applied in angle-closure glaucoma or neovascular glaucoma.
- Trabeculectomy may fail in people with dense scar tissue on the eye surface or advanced neovascular glaucoma; tube surgery may be preferred.
- MIGS methods may not be sufficient in advanced glaucoma and in patients who need a very low target pressure.
How are the examination and tests done?
Glaucoma is not diagnosed with a single test, but by assessing the pressure measurement, the optic nerve examination, the nerve fiber measurement and the visual field test together.
- Tonometry (eye pressure measurement): Either an air-puff measurement or a contact measurement after the eye has been numbed with drops. The pressure changes during the day; in doubtful cases it is repeated at different times.
- Pachymetry (corneal thickness): Measured so that the pressure value can be interpreted correctly.
- Gonioscopy (angle examination): With a special lens, the doctor sees whether the drainage angle is open or closed; this determines the type of treatment.
- Optic nerve examination: The pupil is dilated and the cupping of the nerve head is assessed.
- OCT (optical coherence tomography) nerve fiber analysis: Measures the thickness of the nerve fiber layer; it can show damage before any loss appears in the visual field, and yearly comparisons track progression.
- Visual field test: Maps the losses in the peripheral vision; a 5–10-minute test in which you press a button when you see points of light. The early tests can be misleading until you get used to them; they need to be repeated.
How is glaucoma treated?
The aim of glaucoma treatment is to lower the eye pressure to the target level and so stop the nerve damage from progressing; treatment does not bring back vision that has been lost. The steps are chosen according to the stage and type of the disease; many patients are followed on drop treatment for life.
| Step | For whom? | How is it done? | What to expect, and the limits |
|---|---|---|---|
| Eye pressure drops | The initial option for most patients | Prostaglandin analogues, beta blockers, carbonic anhydrase inhibitors, alpha agonists; alone or in combination; 1–3 times a day | Lowers the pressure by 20–35%; requires regular use every day |
| SLT laser (selective laser trabeculoplasty) | Open-angle glaucoma; as the initial step instead of drops, or in addition to drops | Under drop anesthesia, as an outpatient, 5–10 minutes; low-energy laser to the drainage tissue | Lowers the pressure by a similar amount to drops; the effect may fade over the years and it can be repeated |
| Laser iridotomy | Angle-closure and narrow-angle glaucoma | A small opening is made in the iris to create a new path for the fluid; outpatient, a few minutes | Prevents or treats an acute attack; not applied in the open-angle type |
| Trabeculectomy | Disease that progresses despite drops and laser | In the operating room under local anesthesia; a new drainage channel and a filtering bleb are created in the white of the eye | Strong pressure reduction; can fail because of wound healing, and needs follow-up |
| Tube (drainage implant) surgery | Eyes in which trabeculectomy has failed or is not suitable | A small tube is placed that carries the fluid out of the eye | Effective in advanced cases; tube and corneal problems are monitored |
| MIGS (minimally invasive glaucoma surgery) | Early to moderate stage; often combined with cataract surgery | A micro-implant or an opening procedure in the drainage tissue through small incisions | Faster recovery; the pressure reduction is smaller than with trabeculectomy |
How is glaucoma surgery (trabeculectomy) performed?
- Before surgery, a visual field test, OCT and a general health assessment are done; blood-thinning medicines are adjusted in consultation with the doctor who prescribes them.
- The eye is numbed with a local anesthetic injection around the eye or with anesthetic drops; a sedative is given if needed. In children, general anesthesia is used.
- In the upper part of the eye, in the area hidden under the eyelid, a small flap and an opening are created that let the fluid filter under the thin membrane outside the eye. A medicine may be applied to reduce scar tissue.
- The flap is closed with fine stitches; the operation takes 45–60 minutes. During the operation you feel pressure and see light; how much discomfort is felt varies from person to person.
- The eye is covered; you go home the same day or after one night in hospital. Antibiotic and cortisone drops are used for weeks.
What happens in glaucoma, and what does treatment do?
Circulation of the fluid inside the eye, reduced outflow and the aim of treatment, shown schematically on a cross-section of the front of the eye.
- Normal circulationThe fluid that is produced continuously inside the eye passes through the pupil into the front chamber and drains out through the angle where the cornea and iris meet. Production and outflow are in balance.
- Outflow is reducedWhen the drainage pathway narrows, the fluid cannot leave sufficiently and the eye pressure rises. This rise often causes no pain or symptoms.
- The aim of treatmentDrops, laser or surgery lower the pressure to the target range by reducing production or increasing outflow. The aim is to preserve the vision that remains.
- Why early diagnosis mattersHigh pressure slowly affects the optic nerve; loss begins in the side (peripheral) vision and is noticed late. Vision that has been lost cannot be regained.
What are recovery and follow-up like?
- On drop treatment: The pressure is checked 4–6 weeks after starting the drops. Once the target is reached, a stable patient has an examination every 3–6 months and a visual field test and OCT once a year. Newly diagnosed and progressing cases are checked every 1–3 months.
- After SLT laser: There may be a few hours of blurring and mild aching. The effect settles in 4–6 weeks; the initial check-up is within 1–2 weeks and the second within 6 weeks.
- Day 1 after surgery: A check-up is done. Stinging, watering and blurring are normal. Do not rub the eye, do not lift heavy objects and do not bend over to work.
- Week 1: The drops are used regularly; the pressure and the filtering bleb are checked. A stitch adjustment or extra medicine may be needed. Keep water, soap and dust away from the eye.
- Month 1: Vision slowly clears; check-ups become less frequent. The cortisone drops are reduced step by step.
For patients coming from Elbistan, Afşin, Göksun and the other districts, the day 1 check-up after surgery is done at the hospital; later check-ups are combined with the travel time in mind, and written instructions are given on what to do in an emergency.
Why is sticking to your drops so important?
Glaucoma drops do not relieve any symptoms, so patients may stop them thinking “I can see well”. Every missed day raises the pressure and lets the nerve loss continue. Using the drop at the same time each day, closing the eye after instilling it and pressing the inner corner of the eye with a finger for 1–2 minutes (this reduces how much of the medicine passes into the body), and waiting 5 minutes between two different drops all help you keep to the treatment. Side effects such as redness, stinging, longer eyelashes and darkening of the skin around the eye should be reported to your doctor; do not stop the drops on your own.
What are the risks and limitations?
- Drops: Redness, stinging, dryness, allergy; with prostaglandins, longer eyelashes and darkening of the iris color; with beta blockers, shortness of breath and a slower pulse; with alpha agonists, tiredness and a dry mouth.
- SLT laser: A temporary rise in pressure, mild inflammation; in some patients the effect is insufficient or fades with time.
- Surgery: Infection (a filtering bleb carries a lifelong risk of infection), bleeding inside the eye, the pressure dropping too low, faster development of cataract, a temporary or rarely permanent reduction in vision, closure of the channel by scar tissue and the need for repeat surgery.
- Limitations: No treatment brings back the visual field that has been lost. The success of treatment depends on keeping the pressure at target and on regular follow-up. In some patients the damage may progress slowly even when the pressure is under control.
How do the treatment options compare?
| Feature | Drops | SLT laser | Surgery |
|---|---|---|---|
| Application | At home, every day | Outpatient, 5–10 minutes | Operating room, 45–60 minutes |
| Pressure reduction | Moderate | Moderate | Strong |
| Duration | Lifelong use | Effect may fade over the years; can be repeated | Long-lasting; needs follow-up and sometimes adjustment |
| Main risk | Side effects and missed doses | Temporary rise in pressure | Infection, low pressure, cataract |
| SGK (Turkish social security) | Generally covered | Generally covered | Generally covered |
In patients with glaucoma, cataract surgery can also lower the pressure to some extent and can be combined with MIGS; see the cataract surgery page for more information. For secondary glaucoma caused by uveitis, the uveitis page, and for neovascular glaucoma caused by diabetes, the diabetic retinopathy page will guide you.
Glaucoma treatment in Kahramanmaraş
At HG Hospital in Kahramanmaraş, Türkiye, the diagnosis of glaucoma, drop treatment and surgical treatment (trabeculectomy, tube surgery and, in suitable cases, MIGS) are performed by Dr. Nejmi Öztürk. Suitability for the laser options (SLT, iridotomy) is determined at the examination and with the angle assessment; the step that is right for you is planned together.
Glaucoma examinations, drop treatment, laser and surgery are generally covered by SGK. HG Hospital is a private hospital contracted with the Turkish social security institution (SGK); patients with valid SGK coverage may use it, although a private-hospital co-payment may apply. Patients without SGK coverage, such as international patients and visitors from abroad, pay privately or through their private or travel health insurance; the hospital checks coverage before treatment. Fee information is given by the hospital after the examination, and insurance coverage is clarified at the consultation.
Everyone over the age of 40 in central Kahramanmaraş and its districts, especially those with glaucoma in the family, is advised to have an eye pressure measurement and an optic nerve examination every 2–4 years.
Dr. Öztürk sees patients only at HG Hospital in Kahramanmaraş. For patients coming from Elbistan, Afşin, Göksun, Ekinözü and Nurhak, the pressure measurement, OCT and visual field test are grouped into the same day; drop check-ups are planned around the travel time. For details, see the patients from Elbistan and the surrounding area page.
Dr. Nejmi Öztürk sees patients at HG Hospital in Kahramanmaraş, Türkiye. For patients travelling from other districts or from abroad, examination, tests and treatment planning can be arranged for the same day.
Hospital switchboard (within Türkiye): 444 46 46 · E-mail: info@nejmiozturk.com · HG Hospital, Üngüt Mevkii, Prof. Dr. Necmettin Erbakan Blv. No:209, Onikişubat / Kahramanmaraş, Türkiye
Frequently asked questions
What should eye pressure be?
In most people the pressure inside the eye is between 10 and 21 mmHg. But nerve damage can also develop at normal values, and a high value does not always mean glaucoma. For the diagnosis, the appearance of the nerve head, OCT and the visual field are assessed together; a separate target pressure is set for each patient.
Does glaucoma cause blindness?
Untreated glaucoma can lead to permanent loss of vision and, in the advanced stage, to blindness. When it is diagnosed early and the pressure is kept at target, the great majority of patients keep useful vision for life. Because lost vision does not come back, regular follow-up and sticking to your drops are decisive.
What are the symptoms of high eye pressure?
Open-angle glaucoma causes no symptoms in the early stage; the loss begins silently in the peripheral vision. In the angle-closure type, rings around lights, eye ache and blurring in the evenings are seen. Sudden severe pain, redness and nausea are signs of an acute attack; urgent care is needed.
Do you have to use eye pressure drops for life?
In most patients, yes. Glaucoma is a chronic disease, and the pressure rises again when the drops are stopped. After laser or surgery the number of drops may be reduced, or they may be stopped for a while; this decision is made by the doctor according to the check-up measurements.
What is SLT laser, and can it replace drops?
SLT is an outpatient procedure of 5–10 minutes in which a low-energy laser is applied to the drainage tissue to increase the outflow of fluid. In open-angle glaucoma it can be used as the initial step instead of drops, or added to drops. Its effect may fade over the years and it can be repeated; some patients still need drops.
When is glaucoma surgery needed?
Surgery is recommended if the pressure does not come down to target despite drops and laser, if the visual field loss is progressing, or if the patient cannot use the drops. The method (trabeculectomy, tube, MIGS) is chosen according to the stage, the structure of the angle and any previous operations on the eye.
What is the difference between open-angle and angle-closure glaucoma?
In open-angle glaucoma the drainage angle is open, but the fluid does not drain well enough; the disease is silent and slow. In angle-closure glaucoma the iris blocks the angle; it can cause a sudden attack and is treated with laser iridotomy. The distinction is made with gonioscopy (angle examination).
How often should I come for eye pressure check-ups?
In stable patients an examination every 3–6 months and a visual field test and OCT once a year are enough. After a new diagnosis, a change of drops or progression, check-ups are every 1–3 months.
Do cortisone drops raise eye pressure?
Yes; drops, sprays and tablets containing cortisone (steroids) can raise the pressure inside the eye in susceptible people. Regular pressure measurement is recommended for long-term users of cortisone. Whether the cortisone needs to be stopped is decided together with the doctor who prescribed it.
How much does glaucoma treatment cost?
Fee information is given by the hospital after the examination; SGK and private insurance coverage is clarified at the consultation. Glaucoma examinations, drops, laser and surgery are generally covered by SGK; a private-hospital co-payment may apply. Patients without SGK coverage pay privately or through their private or travel health insurance.
Where can I go for eye pressure treatment in Kahramanmaraş?
The medical and surgical treatment of glaucoma at HG Hospital in Kahramanmaraş is performed by Dr. Nejmi Öztürk. For patients coming from Elbistan and the districts, the tests are grouped into the same day.
Sources
- Turkish Ophthalmological Society — todnet.org
- American Academy of Ophthalmology (AAO) — aao.org
- National Eye Institute (NEI) — nei.nih.gov
Related pages
- Eye diseases and treatments
- Cataract surgery
- Uveitis (inflammation inside the eye)
- Eye doctor in Kahramanmaraş
This page is for information only; diagnosis and treatment decisions are made after an examination. The results of any surgical or interventional procedure may vary from person to person. You are advised to obtain detailed advice from your physician before any procedure.
Ophthalmologist and eye surgeon. Graduate of Erciyes University Faculty of Medicine; completed his residency at Ankara Atatürk Training and Research Hospital. With 21 years of experience in cataract and refractive surgery, strabismus, glaucoma, retina and oculoplastic surgery, he sees patients at HG Hospital in Kahramanmaraş, Türkiye. Biography and training
Dr. Nejmi Öztürk
Ophthalmologist and eye surgeon
HG Hospital, Üngüt Mevkii, Prof. Dr. Necmettin Erbakan Blv. No:209, Onikişubat / Kahramanmaraş
+90 506 377 47 68WhatsAppAppointment formHospital switchboard (within Türkiye): 444 46 46 · info@nejmiozturk.com
- Private patients and private health insurance are welcome; patients with SGK coverage may use it (conditions are confirmed by the hospital)
- Same-day examination and test planning for patients travelling from other districts or from abroad
- Getting here and patient information
- Patients from Elbistan and the region