Internal Goniotomy
Internal goniotomy is part of a group of procedures known as minimally invasive glaucoma surgery. It is particularly well suited to patients with mild to moderate glaucoma who are undergoing cataract surgery.
Glaucoma is a long-term condition in which the optic nerve, the “cable” that carries visual information from the eye to the brain, becomes progressively damaged. Without treatment, this damage can lead to irreversible vision loss, but with early detection and careful management, most people retain useful sight for life.
About glaucoma
In many forms of glaucoma, the fluid pressure inside the eye is too high for the optic nerve to tolerate. Over time, this pressure compresses and damages the nerve fibres, particularly those responsible for peripheral vision. In other forms, optic nerve damage occurs despite “normal” eye pressure, highlighting that pressure is a risk factor but not the only determinant.
The most common type is primary open angle glaucoma, where the drainage angle of the eye appears open, but the drainage system is less efficient. Other types include angle closure glaucoma, secondary glaucomas linked to other eye conditions or medications, and developmental glaucomas present from birth.
One of the challenging aspects of glaucoma is that early disease usually causes no noticeable symptoms. The brain adapts to gradual loss of peripheral vision, and most people feel they see “normally” until damage is more advanced.
As glaucoma progresses, people may become aware of missing areas or “patches” in their side vision, difficulty navigating in dim light, or problems with activities such as driving. In acute angle closure, symptoms are very different, with sudden severe eye pain, redness, blurred vision, halos around lights, and often nausea and vomiting. This is an eye emergency.
Glaucoma results from a combination of factors. Raised intraocular pressure is the most important modifiable risk factor. Family history, increasing age, certain ethnic backgrounds, high myopia, thin corneas, and systemic conditions can all increase susceptibility. Long-term use of steroid medications, particularly steroid eye drops, can also raise the risk.
Not everyone with high pressure develops glaucoma, and some people with normal pressure do, which is why full assessment of the optic nerve and visual fields is essential.
Glaucoma diagnosis involves several complementary tests. Eye pressure is measured, typically with tonometry. The optic nerve is examined and photographed to document its appearance. Optical coherence tomography scans may be performed to measure the thickness of the retinal nerve fibre layer and detect early damage.
Visual field testing assesses the functional impact of any nerve damage by mapping areas of sensitivity in the peripheral and central visual fields. The drainage angle of the eye may be examined with a special mirrored lens to determine whether it is open or narrow. Diagnosis is based on the combined pattern of structural and functional findings, not on pressure alone.
You should see a glaucoma specialist if you have been told you have raised eye pressure, if there is a family history of glaucoma, if your optometrist has noticed suspicious changes in the optic nerve or visual field, or if you experience any sudden onset of severe eye pain and blurred vision. Early referral and treatment are key in preventing avoidable vision loss.
Internal goniotomy is part of a group of procedures known as minimally invasive glaucoma surgery. It is particularly well suited to patients with mild to moderate glaucoma who are undergoing cataract surgery.
Deep sclerectomy has a strong safety profile when performed by experienced glaucoma surgeons. Complications are less frequent than with penetrating glaucoma surgery, although careful follow up is required to ensure pressure remains controlled. At the Eye Doctor Clinic, consultant led care, meticulous surgical technique, and structured follow up are central to achieving safe and durable outcomes.
SLT Laser is a safe, effective and non-invasive treatment that lowers eye pressure by improving natural drainage, making it an excellent option for Open-Angle Glaucoma and OHT.
YAG Iridotomy is a fast, painless laser procedure that prevents angle-closure glaucoma by creating a tiny opening in the iris, allowing fluid to flow normally and keeping eye pressure stable.
Aqueous shunt implants (tubes) Also known as Tube Shunt or Glaucoma Drainage Device Surgery, divert fluid from inside the eye to a reservoir beneath the eyelid, providing reliable long-term pressure control for advanced or complex glaucoma when other treatments are not enough.
Filtration surgery creates a new drainage channel to lower eye pressure and protect the optic nerve in glaucoma. It is a highly effective treatment for moderate to advanced disease when drops or laser are no longer enough.