Because the optic nerve cannot be repaired once it is damaged, the goal of glaucoma treatment is to prevent or slow down further visual field damage, not to improve vision. The current treatment for glaucoma is based on lowering intraocular pressure, and the methods available are: medication, laser, and surgery. We introduce them separately below. Glaucoma medication At present, the treatment of glaucoma is divided into six categories of drugs: a. Pupil constricting agents: pilocarpine or maurobrine, 1% or 2% concentration, it reduces IOP by contracting the ciliary muscle and pulling the scleral protrusion, so that the trabecular network is pulled apart and the outflow of atrial fluid increases. However, the drug can cause pupillary spasm, post-iris adhesions, aggravate cataracts, etc., affecting the observation of glaucoma fundus. Second, β-adrenergic receptor blockers: 0.5% timolol, 0.5% levobunolol, 2% carteolol, 0.25% betaxolol, etc., is through the inhibition of ciliary synapse epithelial cyclic adenosine acid production to reduce atrial aqueous production, to reduce intraocular pressure. However, these drugs have significant effects such as cardiopulmonary function, which can slow down the heart rate, decrease blood pressure, bronchospasm, asthma attacks, fatigue, and drowsiness. Slow heart rate, heart block grade I or higher, and asthma should not use this type of drugs. Third, α-adrenergic agonists: 0.2% brimonidine tartrate, which can simultaneously reduce atrial water production and increase the outflow of atrial water from the uveal-scleral channel and reduce intraocular pressure, in addition to the potential neuroprotective effect. The side effects are commonly dryness of the mucous membranes of the mouth and nose, fatigue, fatigue, drowsiness, etc. Localized, dry eyes, burning sensation, pale conjunctiva, etc. Four, prostaglandin drugs: 0.005% latanoprost, 0.004% travoprost, 0.03% bemiprost, is through the increase of the uveal-scleral channel atrial outflow to reduce intraocular pressure. The magnitude of IOP reduction is large, up to 20%-40%, and there are almost no systemic side effects, but the local can lead to increased periorbital skin and iris pigmentation, eyelash growth and darkening, etc. Fifth, carbonic anhydrase inhibitors: there are oral acetazolamide, acetazolamide tablets, local drops of 1% brinzolamide eye drops, it is directly inhibit the ciliary epithelial cells of carbonic anhydrase to reduce atrial fluid production. Common side effects of oral medications include numbness around the mouth and limbs, lack of appetite, sleepiness, irritability, weakness, frequent urination, etc. Long-term application can also cause hypokalemia and urinary tract stones; topical eye drops mainly cause abnormal taste, bitter sensation in the mouth, blurred vision, burning sensation in the eyes, eye congestion, and increased secretion. It should be noted that such drugs are prohibited for those who are allergic to sulfonamide drugs. Hypertonic agents: 20% mannitol injection, 50% glycerol saline, 20% isosorbide solution, the former intravenous rapid drip, the latter two oral, they are through a short period of time to increase the plasma osmolarity, so that the eye tissue, especially the vitreous humor water into the blood, reducing the volume of intraocular objects to quickly reduce intraocular pressure. However, neither can be applied for a long time. Laser treatment for glaucoma Laser can cause tissue coagulation, vaporization and perforation due to its thermal, photochemical and electromagnetic effects. It is characterized by exact results, little tissue damage, light postoperative reactions, and few complications. The following laser treatments for glaucoma are currently available: a. Nd:YAG laser iridotomy: mainly for acute angle-closure glaucoma in preclinical or remission phase, chronic angle-closure glaucoma without early optic nerve damage and visual field changes, secondary pupillary block type angle-closure glaucoma, another eye with malignant Glaucoma with a history of malignant glaucoma in the other eye is not suitable for surgery, etc. The laser is used to make a hole in the peripheral iris to allow anterior and posterior atrial aqueous traffic and to relieve pupillary block, thus avoiding acute major glaucoma attacks. Argon laser or semiconductor laser peripheral iridoplasty: for closed-angle glaucoma with a partially open atrial angle and an iris bulge. Selective laser trabeculoplasty (SLT): mainly treats primary open-angle glaucoma, normal intraocular pressure glaucoma, pigmentary glaucoma, aphakic glaucoma and open-angle glaucoma with IOL. Laser photocoagulation causes a local inflammatory response, prompting phagocytes to engulf the tissue around the trabecular meshwork, resulting in increased atrial aqueous outflow and lowering IOP. IV. Transscleral continuous wavelength Nd:YAG laser or diode ciliary body photocoagulation, etc.: mainly treats various refractory glaucoma, such as neovascular glaucoma. The laser is used to destroy part of the ciliary body epithelium so that it cannot produce atrial fluid, thus reducing the intraocular pressure. Surgical treatment of glaucoma There are various surgical modalities for anti-glaucoma, generally there are three major categories: i. Intraocular drainage: This mainly refers to peripheral iridectomy, which creates a channel in the peripheral iris between the anterior and posterior chambers to relieve the increased pressure in the posterior chamber and obstruction of the anterior chamber angle caused by pupillary block and to lower the intraocular pressure. It is indicated for primary closed-angle glaucoma in preclinical and remission phases with an atrial angle opening greater than 1/2, as well as for early chronic closed-angle glaucoma. Extraocular drainage: usually called “filtration surgery”, it is the most common way of anti-glaucoma surgery, including: trabeculectomy, scleral cautery, non-penetrating trabeculectomy, etc. Through the new channel formed by surgery, atrial water is drained to the subconjunctiva to form a “filtration bubble “The atrial water is then absorbed by the surrounding tissues, i.e., the atrial water is drained from the eye to the outside of the eye to lower the intraocular pressure. This type of surgery is used for open-angle glaucoma, closed-angle glaucoma where the atrial angle is closed more than 1/2, most secondary glaucoma, and advanced congenital glaucoma where drug therapy has failed. There is also a surgical procedure in which a tube with a valve is implanted in the eye to drain atrial fluid, called a pressure-reducing implant, which is used to lower intraocular pressure by draining atrial fluid through a tube inserted at one end into the anterior chamber and into the subconjunctiva of the dome. This is usually used for some refractory glaucoma with poor visual function, such as: neovascular glaucoma, aphakic or IOL glaucoma, etc. Destructive surgery: This refers to ciliary condensation, which, like ciliary photocoagulation, uses physical therapy to destroy part of the ciliary epithelium to reduce atrial aqueous production to lower intraocular pressure. This type of surgery has more complications and is less predictable. It is generally used for absolute stage glaucoma that has no light perception and for those who still have high IOP after repeated failures of other anti-glaucoma procedures, to address the pain associated with high IOP and has no effect on visual function. In addition, in younger patients with congenital glaucoma, trabeculotomy or anterior chamber angle dissection may be an option. Although there are several treatment options, the choice of treatment plan varies for different glaucoma types. For closed-angle glaucoma, surgical treatment should be the mainstay, and once diagnosed, surgery should be performed as early as possible. Early-stage patients can be cured by performing a peripheral iridotomy. In more advanced cases, however, external drainage surgery (most commonly trabeculectomy) is usually required. However, medications should be used to try to lower the IOP to a normal level before surgery. For patients with open-angle glaucoma, treatment should be given once the diagnosis is clear, and may begin with medication or laser treatment. When damage to the visual field or optic nerve worsens, surgical treatment should be considered. In cases without definite glaucoma, when the IOP exceeds 30 mm Hg, it is not necessary to wait for damage to the visual field or optic nerve to appear before starting treatment because their likelihood of developing glaucoma is very high. Once congenital glaucoma is diagnosed in infants and children, surgery is the preferred treatment and medications should only be used as a pre-surgical preparation. The main goal of treatment is to prevent damage to the optic nerve by lowering the IOP. The amount of IOP required to fall varies from patient to patient, and generally requires a stable IOP between 15-20 mm Hg. Some patients with more severe glaucoma may require lower IOP levels to stop further damage. Even for the same patient, the desired IOP, or “target IOP,” is not constant, and the IOP requirements vary from patient to patient. Because treatment plans need to be adjusted in response to changes in disease, all patients must be followed up regularly. In addition, regular follow-up examinations are also required after glaucoma surgery, both to observe the effectiveness of IOP control and for any surgical complications. Even in eyes that have undergone successful surgery, with the passage of time and changes in physical condition, the IOP may become out of control again and the damage to the optic nerve may worsen, so every patient with glaucoma, whether treated medically or surgically, must follow the doctor’s instructions and requirements for regular follow-up examinations.