Low-Tension Glaucoma Treatment & Management

Updated: Jun 10, 2020
  • Author: Mitchell V Gossman, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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Medical Care

In low-tension glaucoma (LTG), the aim of IOP-lowering medications is for a reduction of at least 30%.

Also see the following clinical guideline summaries:


Surgical Care

Argon laser trabeculoplasty (ALT): This procedure may have minimal effect because the intraocular pressure (IOP) is already in the reference range.

Selective laser trabeculoplasty (SLT): SLT targets pigment-producing cells in the trabecular meshwork with less tissue destruction and scarring compared with ALT.

Trabeculectomy: If medical therapy is ineffective, adjunctive antimetabolite therapy likely is needed for postoperative IOP to be in the single digits. A higher risk of hypotony and endophthalmitis exists when targeting extremely low pressures that may be needed to retard or prevent progression of field loss.



Neurophthalmologist consultation can be ordered to rule out compressive optic neuropathy (as indicated).



An increase in salt intake may be recommended if the patient's diastolic blood pressure is significantly lower than the systolic blood pressure (ie, >70 mm Hg). However, controversy exists regarding this recommendation. Exercise caution in those patients with vascular or cardiac disease.



No restrictions on activity are indicated.


Long-Term Monitoring

After obtaining baseline optic disc photos and/or analysis and visual fields, patients should receive regular follow-up care (eg, at least every 6 months) to monitor for progression of field loss and optic nerve tissue in low-tension glaucoma (LTG).

Evaluate risk factors for defective visual-field progression linked to the following 4 independent predictive factors determined by the Canadian Glaucoma Study [22] :

  • Abnormal anticardiolipin antibody level

  • Higher mean intraocular pressure (IOP) at follow up

  • Higher baseline age

  • Female sex