Management of Swelling and Watering After Glaucoma Surgery
Topical corticosteroids should be prescribed as the primary treatment for managing swelling and watering after glaucoma surgery, with frequent follow-up evaluations to monitor response and adjust treatment as needed. 1
Initial Post-Operative Management
- Perform a follow-up evaluation on the first postoperative day and at least once during the first 1-2 weeks to evaluate visual acuity, intraocular pressure (IOP), and status of the anterior segment 1
- Prescribe topical corticosteroids in the postoperative period to control inflammation 1
- Schedule more frequent follow-up visits for patients with postoperative complications such as increased inflammation, flat or shallow anterior chamber, or early bleb failure 1
Management of Specific Complications
For Bleb-Related Issues:
- If evidence of bleb failure develops (indicated by rising IOP and flattening bleb), undertake additional treatments to improve aqueous flow, including: 1
- Injection of antifibrotic agents
- Bleb massage
- Suture adjustment, release, or lysis
- Bleb needling
For Inflammation and Swelling:
- Continue topical corticosteroids with appropriate frequency based on the severity of inflammation 1
- Monitor for steroid-related complications such as IOP elevation 1
- Consider non-steroidal anti-inflammatory drugs (NSAIDs) as adjunctive therapy in cases of persistent inflammation 1
For Excessive Watering (Epiphora):
- Evaluate for bleb leak if watering is accompanied by low IOP 1
- Repair bleb leak if identified 1
- Consider temporary patching or bandage contact lens for small leaks 1
Follow-up Protocol
- In the absence of complications, perform additional postoperative visits during a 3-month period to evaluate visual acuity, IOP, and status of the anterior segment 1
- For patients with persistent swelling or watering, increase visit frequency to monitor response to treatment 1
- Examine for macular thickening which may occur as a physiological reaction to sudden IOP reduction after glaucoma surgery 2
Patient Education
- Explain that filtration surgery places the eye at risk for endophthalmitis for the duration of the patient's life 1
- Instruct patients to notify their ophthalmologist immediately if they experience symptoms of pain, decreased vision, redness, or discharge 1
- Educate patients about proper administration of prescribed medications and importance of adherence to the treatment regimen 3
Special Considerations
- For patients with persistent inflammation despite standard therapy, consider evaluation for underlying causes such as retained lens material or uveitis 4
- Monitor for macular changes, as studies have shown a slight subclinical increase in macular thickness after uncomplicated trabeculectomy 2
- Be aware that sudden reduction in IOP after glaucoma surgery can alter the relationship between capillary pressure and interstitial fluid pressure, potentially contributing to macular thickening 2
Common Pitfalls and Caveats
- Avoid premature discontinuation of topical corticosteroids, as this may lead to rebound inflammation 1
- Do not ignore persistent watering, as it may indicate a bleb leak which can increase the risk of endophthalmitis 1
- Be vigilant for signs of infection, which requires immediate and aggressive treatment to prevent vision loss 1, 4
- Recognize that excessive manipulation of the bleb during the early postoperative period may increase the risk of complications 5