Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 7 Sept 2026Clinical review pending
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New pain or visual loss after glaucoma treatment
A surgically treated eye can develop excessive or inadequate pressure reduction, inflammation, leakage or infection; bleb-related infection can occur long after the original operation.
Action: Arrange immediate emergency ophthalmic assessment for worsening pain, redness, photophobia, discharge or reduced vision after glaucoma surgery, including in someone whose operation was years earlier.
Synopsis
Explain how glaucoma procedures alter aqueous flow, match procedures to the disease mechanism and visual risk, and recognise complications requiring urgent postoperative assessment.
SLT acts on the trabecular drainage system; peripheral iridotomy creates an iris opening to relieve pupil block; cyclodiode reduces aqueous production.
NICE offers initial 360-degree SLT for eligible non-advanced chronic open-angle glaucoma and higher-risk ocular hypertension, with pigment dispersion excluded from this routine initial offer.
Advanced chronic open-angle glaucoma merits an offer of augmented glaucoma surgery rather than a requirement to exhaust every drop first.
Key red flags
A red painful eye with reduced vision and a previous trabeculectomy is an emergency because infection may involve the filtering bleb or spread inside the eye.
Investigation priorities
01
Mechanism and angle assessment before selecting a procedureFirst step
Determine whether the proposed treatment reaches an appropriate outflow pathway.
Management branches
Initial laser optionOffer SLT to an eligible open-angle patient
A person has newly diagnosed eligible non-advanced disease or is considering laser to reduce treatment burden.
Confirm open-angle anatomy and NICE eligibility, and explain that SLT improves trabecular outflow rather than creating a new surgical drainage channel.
Discuss variable response, possible transient pressure rise and inflammation, and the possibility that drops or repeat treatment will still be needed.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 7 Sept 2026; clinical approval remains outstanding.