Trabeculectomy

What is Trabeculectomy

Trabeculectomy is a procedure to relieve eye pressure caused by glaucoma. Glaucoma is a medical condition that causes fluid (aqueous fluid) to build up inside of the eye. This buildup results in an increase in eye pressure that can damage the nerve you need for eyesight (optic nerve).

Trabeculectomy is also called glaucoma filtration surgery. You may need this procedure if your glaucoma has not been controlled. During the procedure, an opening is created in the white part of the eye (sclera). Fluid drains through this opening into a drainage pocket (bleb) created below the upper eyelid. You may need to have this procedure repeated over time.

Tell a health care provider about:

  • Any allergies you have.
  • All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
  • Any problems you or family members have had with anesthetic medicines.
  • Any blood disorders you have.
  • Any surgeries you have had, including eye surgeries and procedures.
  • Any medical conditions you have.
  • Whether you are pregnant or may be pregnant.
  • Any history of eye injury or infection.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

  • Infection.
  • Bleeding.
  • Allergic reactions to medicines.
  • Damage to other structures or organs near the eye.
  • Closure of the glaucoma filtration hole that is made to lower the eye pressure.
  • Leaking too much eye fluid.
  • Vision loss or double vision.
  • Clouding of the lens in the eye (cataracts).
  • Swelling of the front layer of the eye (cornea).
  • Scarring or detachment of the light-sensitive nerve cells in the back of the eye (macula).
  • Needing to change eyeglass prescription or inability to wear contacts.
  • Drooping eyelid.

What happens before the procedure?

  • You will need a complete eye exam, including a vision test and measurement of your eye pressure.
  • Follow instructions from your health care provider about eating or drinking restrictions.
  • Ask your health care provider about:
    • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
    • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
  • Plan to have someone take you home after the procedure.
  • If you go home right after the procedure, plan to have someone with you for 24 hours.

What happens during the procedure?

  • To reduce your risk of infection:
    • Your health care team will wash or sanitize their hands.
    • Your skin will be washed with soap.
  • An IV tube will be inserted into one of your veins.
  • You will be given one or more of the following:
    • A medicine to help you relax (sedative).
    • A medicine to numb the area (local anesthetic). This may be given as eye drops or injections.
    • A medicine to make you fall asleep (general anesthetic).
  • A device will be placed to keep your eye open (eyelid speculum).
  • You may be given injections of a medicine that prevents eye movement.
  • A trapdoor-like flap will be created in the upper part of the sclera.
  • An opening into your eye will be made near the flap.
  • A drainage channel for fluid from inside your eye will be created.
  • The flap will be replaced with small stitches (sutures).
  • Antibiotic eye drops and anti-inflammatory eye drops may be put in your eye.
  • You may get a type of medicine that prevents the glaucoma filtration hole from closing. You may also get injections to prevent inflammation, scarring, and infection.
  • Your eye will be covered with an eye patch and a protective shield.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

  • Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often until the medicines you were given have worn off.
  • You will be given an appointment to return to your eye surgeon.
  • Do not drive for 24 hours if you received a sedative.

Trabeculectomy, Care After

Refer to this sheet in the next few weeks. These instructions provide you with information about caring for yourself after your procedure. Your health care provider may also give you more specific instructions. Your treatment has been planned according to current medical practices, but problems sometimes occur. Call your health care provider if you have any problems or questions after your procedure.

What can I expect after the procedure?

After the procedure, it is common to have:

  • Eye redness.
  • Eye irritation.
  • Tearing.
  • Blurred vision.

Follow these instructions at home:

Driving

  • Do not drive or operate heavy machinery until your health care provider approves.
  • Do not drive for 24 hours if you received a medicine to help you relax (sedative).

Activity

  • Do not have sex until your health care provider approves.
  • Do not lift or push anything that is heavier than 10 lb (4.5 kg) until your health care provider approves.
  • Do not strain or bend over, as told by your health care provider.
  • Ask your health care provider when you can return to work.
  • Rest as told by your health care provider. Do not do any strenuous activities, such as sports, until your health care provider approves.

Lifestyle

  • Protect your eye with glasses or sunglasses.
  • Do not wear contact lenses unless told by your health care provider.
  • Do not wear eye makeup until your health care provider approves.
  • Do not bump or rub your eye.
  • When bathing and showering, keep the water below your neck. Ask someone to help you shampoo your hair. Do not get water in your eye when shampooing your hair, bathing, or showering.
  • If you normally sleep on your side, lie so that your affected eye is on top.

General instructions

  • Take over-the-counter and prescription medicines only as told by your health care provider. This includes all eye drops. Some of these drops may need to be continued for several months.
  • Follow instructions from your doctor about how to take care of your incision. Leave stitches (sutures) in place until your health care provider removes them.
  • Clean your eye as told by your health care provider.
  • Wear your hard eye patch as told by your health care provider. After your health care provider removes your eye patch, you may still need to wear your eye shield at night.
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

  • You have a fever.
  • You continue to have redness, tearing, or irritation.
  • You have blurred vision that lasts longer than 6 weeks.
  • Your eyelid droops.
  • You have any change in your vision.
  • You have pain.
  • You have swelling in your eye or around your eye.
  • You have blood, pus, or discharge coming from your eye.
  • Your eyes are very sensitive to light.

Get help right away if:

  • You have severe eye pain.
  • You have sudden vision loss.
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