Hearing that glaucoma surgery might be part of your future can be unsettling. The good news is that surgery is rarely the first step. Most people with glaucoma manage their condition for years with prescription eye drops and, when needed, an in-office laser treatment, long before surgery becomes part of the conversation.

Still, if your eye doctor has mentioned surgery as a possibility, it helps to know what that actually involves. This guide walks through when surgery becomes necessary, the different procedures used to treat glaucoma, what to expect before and after, and how our team at Garibaldi Eye Care fits into that process.

When Is Glaucoma Surgery Necessary?

Glaucoma is typically treated in steps. Most people start with prescription eye drops to lower eye pressure. If drops alone aren’t enough, or if you have trouble using them consistently, an in-office laser procedure is often the next step. Surgery is usually considered when:

• Eye pressure remains too high despite medication and laser treatment
• Optic nerve damage continues to progress even with treatment
• You can’t tolerate or consistently use the eye drops you’ve been prescribed
• You have narrow or closed angles that put you at risk of a sudden, dangerous pressure spike

For a broader look at how glaucoma develops and is diagnosed, see our guide to what glaucoma is. If you’ve been told you have narrow angles specifically, our narrow angle glaucoma page covers laser peripheral iridotomy in more detail.

Types of Glaucoma Surgery

“Glaucoma surgery” isn’t one single procedure — it’s a category that includes quick in-office laser treatments and more involved operating-room surgeries. Which one is appropriate depends on your type of glaucoma, how advanced it is, and your overall eye health.

Laser Trabeculoplasty (SLT/ALT)

This is the most common glaucoma laser procedure and treats open-angle glaucoma. A laser targets the eye’s natural drainage tissue (the trabecular meshwork) to help fluid drain more efficiently. Selective laser trabeculoplasty (SLT) has largely replaced the older argon laser version (ALT) because it can be repeated if needed. It’s done in the office and takes only a few minutes.

Laser Peripheral Iridotomy (LPI)

LPI treats narrow or closed-angle glaucoma by creating a tiny opening in the iris so fluid can bypass the blockage. We cover this procedure — including what to expect step by step — in detail on our narrow angle glaucoma page.

Minimally Invasive Glaucoma Surgery (MIGS)

MIGS refers to a newer group of procedures that use microscopic devices to improve drainage with smaller incisions than traditional surgery. Recovery is generally faster, and MIGS is often performed at the same time as cataract surgery in patients who have both conditions.

Trabeculectomy

A traditional filtering surgery performed in an operating room. The surgeon creates a small opening in the white part of the eye (the sclera) to give fluid a new pathway to drain, lowering eye pressure. It’s generally reserved for more advanced cases or when other treatments haven’t controlled pressure well enough.

Tube Shunt (Drainage Implant)

A small tube is implanted to help drain fluid from the eye. Like trabeculectomy, this is an operating-room procedure typically considered when other treatments haven’t sufficiently controlled pressure.

What Happens Before, During, and After Surgery

Before Surgery

• A comprehensive eye exam and discussion of your specific situation and goals
• A review of your medications, including whether you need to pause blood thinners or NSAIDs beforehand
• Arranging a driver, if your procedure involves sedation or anesthesia

During Surgery

Laser procedures are usually done right in the eye doctor’s office using numbing eye drops — no needles, no operating room. MIGS, trabeculectomy, and tube shunt procedures take place in an operating room, typically with local anesthesia and sedation (you’re awake but comfortable) rather than general anesthesia. Most glaucoma surgeries, including the operating-room procedures, are outpatient — you go home the same day.

After Surgery

You’ll have one or more follow-up visits to check your eye pressure and healing. Most procedures involve using eye drops for a period afterward, and you’ll be asked to avoid rubbing your eye and, for some procedures, avoid heavy lifting for a while.

How Long Is Recovery?

• Laser procedures (SLT, LPI): back to normal activities within 24 to 48 hours
• MIGS: typically a few days to about a week, similar to cataract surgery recovery
• Trabeculectomy or tube shunt: several weeks, with activity restrictions during that time

Your surgeon will give you a recovery timeline specific to your procedure and your eyes.

Risks, and What Surgery Can (and Can’t) Do

It’s important to have realistic expectations. Glaucoma surgery cannot restore vision that’s already been lost — its goal is to protect the vision you have left by lowering eye pressure and slowing further optic nerve damage.

As with any procedure, there are risks, which vary by surgery type and are generally uncommon. They can include infection, bleeding, temporarily low eye pressure, or (with some procedures) a higher chance of developing cataracts later. Your surgeon will go over the specific risks and likelihood for the procedure they’re recommending for you — this is a conversation worth having in detail before you decide.

What Does Glaucoma Surgery Cost in BC?

Glaucoma surgery is considered medically necessary, and in British Columbia, medically necessary eye surgery is generally covered by MSP (the province’s public health plan). Your out-of-pocket costs, if any, typically come down to things like prescription eye drops during recovery. Because coverage details can depend on the specific procedure and provider, it’s worth confirming the specifics with your care team and MSP directly.

Who Performs Glaucoma Surgery?

Glaucoma surgery — whether laser or operating-room — is performed by an ophthalmologist, a medical doctor who specializes in eye surgery. Optometrists, including the doctors at Garibaldi Eye Care, diagnose and manage glaucoma but do not perform these surgical procedures.

Here’s how our optometrists in Squamish fit into your care: we provide comprehensive glaucoma exams and ongoing monitoring using tonometry, gonioscopy, optic nerve imaging, and visual field testing. We manage your condition with prescription eye drops for as long as that’s the right course of treatment. And if surgery becomes the appropriate next step, we coordinate your referral to an ophthalmologist and continue to work alongside them for your pre- and post-operative care.

If you have glaucoma, are at higher risk for it, or haven’t had a comprehensive eye exam recently, book an appointment with our team. Early, consistent monitoring is what keeps most people managing glaucoma with drops alone for as long as possible — and it’s the first step no matter what path your treatment eventually takes.

Frequently Asked Questions

Is glaucoma surgery dangerous?

Serious complications are uncommon, and for most people the risk of untreated, worsening glaucoma outweighs the risk of the procedure. That said, every surgery carries some risk, and your surgeon will walk you through what applies specifically to the procedure they’re recommending.

What’s the success rate of glaucoma surgery?

Success rates vary by procedure and by how advanced the glaucoma is, which is why your surgeon is the best source for a number that applies to your specific situation. In general, most patients see meaningful, lasting pressure reduction, though some may need additional treatment over time.

How long does the procedure itself take?

Laser procedures typically take just a few minutes. MIGS procedures vary depending on whether they’re combined with cataract surgery. Trabeculectomy and tube shunt procedures can take up to about an hour.

Will I still need eye drops after surgery?

Possibly, though many patients are able to reduce how many drops they need, and some can stop certain drops altogether. This depends on the procedure and how your eyes respond.

Is there a cure for glaucoma?

No — there’s currently no cure for glaucoma, and any vision already lost to it can’t be restored. What surgery, laser treatment, and eye drops can do is control eye pressure effectively enough to protect the vision you still have, often for the rest of your life.

If you have questions about glaucoma surgery or want to know where you stand in your own treatment plan, contact Garibaldi Eye Care to schedule a comprehensive glaucoma evaluation.

Not sure what your next step should be? Your eye doctor in Squamish at Garibaldi Eye Care can help you find out.