What is a trabeculectomy?
Glaucoma is a group of conditions in which the optic nerve is damaged, often in association with raised intraocular pressure (the pressure inside the eye). Lowering that pressure is currently the only proven way to slow progression and help protect the remaining field of vision. Damage that has already occurred cannot be reversed, so the aim of treatment is preservation rather than restoration of sight.
A trabeculectomy is a form of filtration surgery. The surgeon creates a small, carefully controlled channel that allows fluid (aqueous humour) to drain from inside the eye into a space beneath the thin outer membrane of the eye, known as the conjunctiva. This forms a small reservoir called a bleb, from which the fluid is gradually absorbed. Because the fluid bypasses the eye’s natural, blocked drainage pathway, the internal pressure falls.
Key points to understand:
- It is a surgical, pressure-lowering procedure, not a treatment that improves existing vision.
- It is usually performed as a day-case operation under local anaesthetic.
- It is generally considered a more powerful pressure-lowering option than drops or laser, but it carries more risk and requires closer follow-up.
- Many patients are able to reduce or stop their glaucoma eye drops afterwards, though this cannot be promised.
Trabeculectomy is one of several options within a wider glaucoma pathway that also includes medication, selective laser trabeculoplasty (SLT), minimally invasive glaucoma surgery (MIGS) and drainage implants. Guidance from NICE and the Royal College of Ophthalmologists supports a stepped approach, with surgery considered where clinically appropriate.
Who may benefit from trabeculectomy surgery?
Suitability is always individual and depends on the type and stage of glaucoma, the pressure target, the health of the eye and your general health. Trabeculectomy may be considered for people who:
- have advanced or rapidly progressing glaucoma, particularly where vision is already affected
- have eye pressure that remains too high despite maximum tolerated medical treatment
- experience side effects, allergy or intolerance to glaucoma drops
- find it difficult to use drops reliably, for example because of arthritis, tremor or memory difficulties
- have had laser treatment or MIGS that has not achieved a low enough pressure
- require a particularly low target pressure to protect a nerve that is already vulnerable
Glaucoma is often symptomless in its early stages, which is why it is frequently detected during routine optician checks. Symptoms that should prompt specialist assessment include gradual loss of side vision, difficulty adjusting to low light, bumping into objects, or, in acute angle closure, sudden eye pain, redness, haloes and blurred vision, which requires urgent care.
Conditions this surgery may be used for
- Primary open-angle glaucoma
- Angle-closure glaucoma, including after acute angle closure has been stabilised
- Pigmentary and pseudoexfoliative (secondary) glaucoma
- Normal-tension glaucoma requiring a very low target pressure
- Ocular hypertension with high risk of progression, in selected cases
- Glaucoma that has progressed despite drops, SLT or previous surgery
Potential benefits
Outcomes vary between patients, and no procedure can guarantee a particular result. Where surgery is successful, trabeculectomy may:
- achieve a substantial and sustained reduction in intraocular pressure
- reduce the risk of further optic nerve damage and field loss
- reduce or remove the need for daily eye drops, easing the treatment burden
- help stabilise glaucoma in eyes that have not responded to other treatments
- support long-term management with fewer pressure fluctuations
Any vision already lost to glaucoma cannot be recovered, and continued monitoring remains essential after surgery.
Consultation and assessment
Before recommending surgery, Ms Diana Urbaneja carries out a detailed assessment. This usually includes:
- a full review of your symptoms, medical history, medications and previous eye treatment
- measurement of intraocular pressure and corneal thickness
- examination of the optic nerve and drainage angle, including gonioscopy
- visual field testing and OCT imaging of the optic nerve and retinal nerve fibre layer
- discussion of your target pressure and rate of progression over time
- a clear conversation about risks, benefits, alternatives and the option of continuing current treatment
Alternatives such as laser, MIGS or a change of medication will always be discussed, and a personalised plan agreed with you.
How the procedure is performed
Trabeculectomy is normally carried out as day surgery in a hospital or surgical unit, taking around 45 to 60 minutes. Most patients have local anaesthetic, given as drops and an injection around the eye, so the eye is numb and you remain awake but comfortable. Sedation may be offered where appropriate.
In outline, the surgeon lifts a small flap in the outer wall of the eye, creates a tiny drainage opening, and secures the flap with fine sutures so that fluid escapes at a controlled rate. An anti-scarring medication is often applied to reduce the risk of the channel closing. The eye is then padded and shielded. You go home the same day, with drops and clear written aftercare instructions.
Recovery and aftercare
Recovery differs from person to person. Vision is commonly blurred for several weeks while the eye settles, and the eye may feel gritty, watery or slightly sore. Most people need anti-inflammatory and antibiotic drops for a number of weeks, tapered according to how the eye responds.
Typical guidance includes:
- frequent follow-up appointments in the first weeks, often weekly at first, as the bleb is monitored and sutures may be adjusted or released
- avoiding rubbing or pressing the eye, and using the protective shield at night as advised
- avoiding swimming, heavy lifting, strenuous exercise and dusty environments until cleared
- keeping soap and water out of the eye
- discussing driving and return to work at your review, as this depends on vision and occupation
Seek prompt advice if you develop increasing pain, marked redness, discharge, a sudden drop in vision or flashes and floaters.
01
Consultation
Assessment for advanced glaucoma
02
Surgery
Trabeculectomy, day case
03
Aftercare
Close monitoring & drops
Guide Price
Price TBC
Priced according to your individual case. See the pricing page for all options.
At a glance
Anaesthetic
Local
Procedure time
~45-60 min
Stay
Day case
Recovery
Approx. 3 months
Follow-up
Close monitoring