In short: the Xen 45 gel stent is a 6 mm soft gelatin tube placed through a keyhole incision to create a gentle new drainage channel and a low fluid reservoir (bleb) under the lining of the eye. It lowers pressure into the mid-teens for open-angle glaucoma that is no longer controlled by drops, with faster recovery and less surgical trauma than a traditional trabeculectomy.
What is the Xen gel stent?
Glaucoma damages the optic nerve when fluid cannot drain freely and pressure inside the eye rises. When drops and laser no longer keep your pressure on target, surgery can create a new drainage route. The Xen 45 (AbbVie / Allergan) is the world’s most widely used keyhole bleb-forming device.
It is a 6 mm tube made from soft, gelatin (the same family of material used in dissolvable stitches), with a fine 45-micrometre channel. It is placed “ab interno” — through a tiny clear-corneal incision, with no need to cut the conjunctiva in the standard technique — so that fluid drains into a low, diffuse bleb. An anti-scarring agent (mitomycin-C) is applied during surgery to help the drain stay open. In trials and large real-world studies, Xen lowers average pressure from around 22 to about 14 mmHg at one year, with most patients reducing or stopping their drops.
Your options
Your consultant will recommend the approach that matches your target pressure, the health of your conjunctiva and whether you also have a cataract.
Not sure whether Xen, PreserFlo or a keyhole MIGS is right for you? A consultant assessment makes it clear.
Book your assessmentHow the procedure works
Xen is a day-case operation, usually under a local anaesthetic with light sedation (general anaesthetic is available if you prefer). It is quick — typically 15–25 minutes — and there are no external stitches in the standard approach.
Before — assessment
Your consultant confirms uncontrolled open-angle glaucoma with pressure checks, gonioscopy, OCT of the optic nerve and visual fields, and sets your target pressure. Healthy conjunctiva helps the bleb succeed.
In theatre — 15–25 minutes
Through a tiny corneal incision, mitomycin-C is applied to limit scarring and the pre-loaded inserter places the Xen stent across the wall of the eye under direct view, so fluid drains into a low bleb.
Same day — home
You go home the same day with a shield and a course of antibiotic and anti-inflammatory drops. Arrange someone to drive you home.
Recovery
Vision is usually blurry for one to three days and returns to near its pre-operative quality within one to two weeks — faster than after a trabeculectomy. You’ll use intensive anti-inflammatory drops that are tapered over 8–12 weeks, and your glaucoma drops in that eye are usually stopped from day one. Around one in three eyes needs a quick “needling” in clinic in the first six months to keep the bleb draining — this is an expected part of the pathway, not a failure. Most patients are back to desk work in 5–10 days, driving at one to two weeks once vision is stable, and full exercise at 4–6 weeks. Glaucoma needs lifelong monitoring.
Cost
At our partner clinics across southern England, private Xen gel stent surgery is typically £4,800–£7,200 per eye, all-inclusive of the consultant glaucoma surgeon, the Xen device, mitomycin-C, day-case theatre and the structured first-year review schedule. Combined with cataract surgery it is usually £5,800–£8,800 per eye depending on the lens chosen, and a two-eye pathway is £9,200–£13,500. Many patients spread the cost with 0% finance. Book a consultation from £240 for a personalised quote, or see our full price list.
Frequently asked questions
How much does private Xen gel stent surgery cost in the UK?
At our partner clinics in southern England, private Xen gel stent surgery is typically £4,800–£7,200 per eye, all-inclusive of the consultant glaucoma surgeon, the Xen device, mitomycin-C, day-case theatre and the structured first-year review schedule. Combined with cataract surgery it is usually £5,800–£8,800 per eye depending on the lens chosen, and a staged two-eye pathway is £9,200–£13,500. Book a consultation from £240 for a personalised quote.
What is the Xen gel stent and how does it work?
The Xen 45 (AbbVie / Allergan) is a 6 mm soft gelatin micro-stent with a fine 45-micrometre channel. It is placed through a tiny keyhole incision — with no conjunctival cut in the standard technique — so that fluid drains from inside the eye into a low reservoir (bleb) under the lining, lowering pressure. An anti-scarring agent (mitomycin-C) is applied during surgery to help the drain stay open. It is the most widely used keyhole bleb-forming device worldwide.
What pressure can Xen achieve, and will I still need drops?
In trials and large real-world studies, Xen lowers average pressure from around 22 to about 14 mmHg at one year, with roughly 60–75% of eyes needing no glaucoma drops and 80–90% reaching a satisfactory pressure with or without drops. It is best suited to mid-teens target pressures; if your optic nerve needs a very low target, a trabeculectomy or PreserFlo may be recommended instead. Lifelong monitoring continues even when drops are stopped.
Is Xen surgery safe, and what is bleb needling?
Xen has a good safety profile in experienced hands. The main early issue is a temporary low pressure (hypotony) in about 5–15% of eyes, which usually settles. Around 20–35% of eyes need a quick “needling” in clinic during the first six months — a brief procedure under anaesthetic drops to clear early scarring around the bleb and restore flow. This is an expected part of the Xen pathway, not a failure. Bleb-related infection is uncommon (under about 0.5% per year) but is a lifelong consideration with any bleb-forming surgery.
What is recovery like, and when can I drive?
Vision is usually blurry for one to three days and returns to near normal within one to two weeks — faster than after a trabeculectomy. You’ll use anti-inflammatory drops tapered over 8–12 weeks. Most patients are back to desk work in 5–10 days, driving at one to two weeks once vision is stable and meets the DVLA standard, and full exercise at 4–6 weeks. Avoid eye-rubbing and swimming while the bleb heals.
Does private insurance or the NHS cover Xen?
Bupa, AXA Health, Aviva, Vitality and WPA generally cover Xen for open-angle glaucoma with pre-authorisation, provided your policy covers chronic eye conditions and your surgeon is recognised — we prepare the pre-authorisation package for you. Xen is also NHS-commissioned under NICE guidance IPG612, but waits in 2026 are typically 12–30 weeks; the private pathway compresses this to one to three weeks with a named consultant throughout.