Every glaucoma treatment works by lowering the pressure inside the eye to protect the optic nerve. The ladder runs from daily eye drops and SLT laser (both first-line options), through minimally invasive glaucoma surgery (MIGS), to traditional drainage surgery for advanced or uncontrolled disease.
Fast answer: how is glaucoma treated?
Glaucoma damages the optic nerve, usually because the pressure inside the eye is too high, and the one proven way to slow it is to lower that pressure. In the UK in 2026 the main options are:
- Eye drops — the traditional first-line treatment; one or more daily drops lower pressure.
- Selective laser trabeculoplasty (SLT) — a quick, painless clinic laser that is now frequently offered as a first-line, drop-free alternative.
- Minimally invasive glaucoma surgery (MIGS) — tiny implants or procedures, low risk, often combined with cataract surgery.
- Traditional drainage surgery (trabeculectomy, tube/shunt, microshunt) — for advanced disease or when other options fail.
Honest one-liner: there is no cure for the optic-nerve damage already done, so the whole aim is to lower pressure enough to stop further loss — and the modern trend is to consider SLT laser early rather than committing to lifelong drops.
Eye drops
Pressure-lowering eye drops are effective and widely used. The main classes are:
- Prostaglandin analogues (e.g. latanoprost) — usual first choice, once daily, increase fluid outflow.
- Beta-blockers (e.g. timolol) — reduce fluid production.
- Alpha agonists (e.g. brimonidine) — reduce production and increase outflow.
- Carbonic anhydrase inhibitors (e.g. dorzolamide, brinzolamide) — reduce production.
Drops work well when used consistently, but they require lifelong daily use, can cause stinging, red eyes or other side effects, and depend entirely on remembering to instil them. Poor adherence is a common reason glaucoma progresses despite treatment.
Selective laser trabeculoplasty (SLT)
SLT uses a low-energy laser to stimulate the eye’s natural drainage channel (the trabecular meshwork) to work better, lowering pressure without drops. It is performed in clinic in a few minutes, is essentially painless, and can be repeated.
- First-line option: major UK and international evidence (the LiGHT trial) supports offering SLT as an initial treatment, and many patients remain drop-free for years afterwards.
- Quick and low-risk: no incision, rapid recovery, minimal side effects.
- Not always permanent: the effect can wear off over time; SLT can be repeated or drops added later.
Read more: SLT laser glaucoma treatment cost.
Minimally invasive glaucoma surgery (MIGS)
MIGS is a family of newer, low-risk procedures that improve drainage using tiny stents or microscopic channels. They are quicker and safer than traditional surgery and are frequently performed at the same time as cataract surgery, addressing both problems in one operation.
- Trabecular stents (e.g. iStent, Hydrus microstent) — tiny implants that bypass the blocked meshwork.
- Microshunts and gel stents (e.g. PreserFlo, Xen) — create a controlled new drainage route for greater pressure reduction.
- Best for: mild to moderate glaucoma, often combined with cataract surgery; lower risk than trabeculectomy but usually a more modest pressure reduction.
Read more: iStent MIGS · Hydrus microstent · PreserFlo microshunt · Xen gel stent.
Recently diagnosed, or struggling with drops? A glaucoma assessment measures your pressure, optic nerve and visual field and matches you to the right step on the treatment ladder.
Book an assessmentTraditional drainage surgery
For advanced glaucoma, or when drops, laser and MIGS have not controlled the pressure, traditional drainage surgery gives the largest and most reliable pressure reduction:
- Trabeculectomy — the long-established gold standard; creates a new drainage channel under the eyelid.
- Tube (drainage) implants (e.g. Paul, Baerveldt, Ahmed) — a small tube channels fluid to a plate at the back of the eye.
These achieve lower target pressures than MIGS but carry more recovery and a slightly higher risk profile, so they are reserved for moderate-to-advanced disease.
Read more: Private glaucoma surgery cost · About glaucoma treatment.
The glaucoma treatment ladder at a glance
| Option | Invasiveness | Best suited to |
|---|---|---|
| Eye drops | None | Most newly diagnosed patients |
| SLT laser | Minimal (clinic laser) | First-line, or to reduce drops |
| MIGS (stent / microshunt) | Low (day case) | Mild–moderate, often with cataract |
| Trabeculectomy / tube | Higher (day case) | Moderate–advanced or uncontrolled |
Treatment is tailored to your pressure, the stage of optic-nerve damage, your visual field and how well you tolerate drops. Many patients move up or down the ladder over time.
Frequently asked questions
What are the main treatment options for glaucoma?
Is SLT laser better than glaucoma eye drops?
What is MIGS and who is it for?
When is traditional glaucoma surgery needed?
Can glaucoma be cured?
What are the side effects of glaucoma eye drops?
Can glaucoma surgery be combined with cataract surgery?
Sources and methodology
- Clinical guidance: NICE NG81 (glaucoma diagnosis and management), Royal College of Ophthalmologists glaucoma guidance.
- Evidence: the LiGHT trial on SLT as first-line treatment for open-angle glaucoma.
- Editorial review: reviewed by a UK GMC-registered consultant glaucoma surgeon before publication.
Independent sources we reference: NICE NG81, Royal College of Ophthalmologists and NHS glaucoma.
Editorial information · not a substitute for personalised medical advice. Treatment suitability is confirmed by a UK GMC-registered consultant glaucoma surgeon at consultation.