PostOp Eyes

Tube Shunt Surgery (Glaucoma Drainage Device) Recovery: What to Expect

Illustration for tube shunt surgery recovery

General information about typical recovery, not medical advice. Every eye and every surgery is different, and your surgeon's instructions override anything on this page. Read our full disclaimer.

Tube shunt surgery, also called a glaucoma drainage device or aqueous shunt, places a small soft tube in the front of the eye that carries fluid back to a plate stitched to the wall of the eye behind the eyelid. The American Academy of Ophthalmology describes the device as a soft, flexible tube connected to a small plate, with fluid collecting in a pool over the plate and then being absorbed by the body. The most common brands are the Ahmed, which has a valve, and the Baerveldt and Molteno, which do not.

The American Academy of Ophthalmology says this surgery usually takes about an hour or less, that your eye may be patched overnight, and that blurry vision for several days to a few weeks is expected. Compared with trabeculectomy, the American Academy of Ophthalmology describes a less burdensome postoperative care regimen, and the American Academy of Ophthalmology says you will need follow up a few times in the weeks after surgery rather than the near weekly schedule a trabeculectomy usually needs.

Two things about this recovery surprise people. First, the valved and non valved devices behave differently in the first two months. BrightFocus Foundation explains that a non valved device such as a Baerveldt is tied off at surgery and only opens when the surgeon placed sutures dissolve or are removed, approximately 4 to 6 weeks after surgery. Second, pressure often rises again before it settles down. EyeWiki describes a hypertensive phase of elevated pressure, typically in the 30 to 50 mm Hg range, occurring anywhere between 1 and 6 weeks after surgery, and says it is more common with valved implants.

The tube is covered by a patch graft, which EyeWiki says can be processed pericardium, sclera, fascia lata, dura, or cornea. That patch can look like a slightly raised lighter area on the white of the eye near where the tube enters. Everything on this page is general expectation setting. Your glaucoma surgeon's instructions override everything here.

The typical timeline

Typical full recovery: 4-8 weeks, longer for pressure to settle. Ranges below are what published guidance describes for most people; your surgeon may set different limits for your eye.

StageWhat to expectRestrictions
Surgery day and the first 24 hoursDay 0-1This is outpatient surgery. The American Academy of Ophthalmology says a glaucoma drainage implant procedure usually takes about an hour or less and that your ophthalmologist may patch your eye, which you may need to wear overnight. The Glaucoma Research Foundation says glaucoma surgeries are generally outpatient procedures lasting about 20 to 40 minutes in a day surgery unit or ambulatory surgery center, and that patients get local anesthesia with sedation. StatPearls lists the Molteno, Baerveldt, and Ahmed among the drainage devices used for glaucoma, so ask which one you received, because the first two months differ between them. Vision in the operated eye is usually very blurry, and the eye feels sore and scratchy.Arrange a ride home. The American Academy of Ophthalmology says you cannot bend over, strain, or lift heavy objects as you recover. The Glaucoma Research Foundation advises keeping water out of the eye for at least one week after incisional glaucoma surgery.
The first weekDay 2-7The eye is usually red, watery, and scratchy this week, and the plate area under the upper lid can ache. The American Academy of Ophthalmology says medicines are prescribed for several weeks after the procedure to help prevent infection and scarring. EyeWiki describes a topical antibiotic and steroid started four times daily and continued for 4 to 6 weeks. Which glaucoma drops you stay on depends on the device. EyeWiki notes that with valved implants the preoperative glaucoma medications are discontinued, while with non valved implants they are continued until the capsule forms around the plate.The Glaucoma Research Foundation advises avoiding driving, reading, bending, and heavy lifting, and says heavy lifting and other strenuous activities should be avoided for at least one week. The American Academy of Ophthalmology says no swimming or direct water exposure to the eyes after a tube implant, and to avoid lifting, bending, or straining until your doctor clears you.
Weeks 2 to 3, the eye starts to calmDay 8-21Redness and the gritty feeling usually start easing as surface stitches loosen. The American Academy of Ophthalmology says blurry vision after a drainage implant lasts several days to a few weeks, so many people notice real improvement in this window. The American Academy of Ophthalmology also says you will need to be seen a few times in the weeks after surgery. Some people first become aware of the plate as a fullness or ache under the upper outer eyelid once the swelling drops, and some notice double vision when looking in certain directions.Restrictions from week one generally continue. Keep water out of the eye, no rubbing, and no lifting, bending, or straining until your surgeon clears you.
Weeks 3 to 8, tube opening and the hypertensive phaseDay 22-56This is the window that surprises people. With a non valved device such as a Baerveldt, BrightFocus Foundation says the tube opens when the surgeon placed sutures dissolve or are removed approximately 4 to 6 weeks after surgery, so eye pressure can drop noticeably around then, and glaucoma drops may finally come off. With a valved device such as an Ahmed, the tube works from day one, but a scar capsule forms around the plate and pressure often climbs. EyeWiki describes this hypertensive phase as elevated pressure typically in the 30 to 50 mm Hg range occurring anywhere between 1 and 6 weeks after surgery, and says it is more common with valved implants than non valved ones. EyeWiki lists management as medical therapy, digital massage, bleb needling with or without 5 fluorouracil, or surgical revision. A pressure spike in this window usually means added drops for a while, not a failed surgery.Do not add, stop, or change any glaucoma drop on your own during this phase, because what the pressure is doing depends on which device you have and where you are in the capsule healing. Continue avoiding heavy lifting, bending, and straining until cleared, and keep water out of the eye.
Months 2 to 6 and beyondMonth 2-6+Most people are back to normal activity and the eye looks close to normal, though the patch graft over the tube may stay visible as a slightly raised lighter patch. EyeWiki says the topical antibiotic and steroid are typically continued 4 to 6 weeks, so drops usually finish before this phase. Long term, EyeWiki lists possible late issues including tube obstruction, tube erosion through the conjunctiva, corneal decompensation, hyphema, and strabismus. The American Academy of Ophthalmology lists double vision, cataract, corneal swelling, and the possible need for a second glaucoma surgery or removal of the implant among the risks. BrightFocus Foundation notes infection can occur months to years after the operation.Normal activity is usually fine once cleared. For life, protect the eye from blows, do not rub it, and treat a red, painful eye as urgent. The American Academy of Ophthalmology says to call immediately if your eye is red, painful, or just does not feel right, because that could be a sign of infection that must be treated right away.

Day by day

When can I...

Is this normal?

Common questions

How long does it take to recover from tube shunt surgery?
The American Academy of Ophthalmology says the surgery usually takes about an hour or less, that your eye may be patched overnight, and that blurry vision lasts several days to a few weeks. EyeWiki describes topical antibiotic and steroid drops continued for 4 to 6 weeks. Eye pressure takes longer to settle than vision does, especially with a non valved device, because BrightFocus Foundation says the tube only opens when the sutures dissolve or are removed approximately 4 to 6 weeks after surgery.
Why did my eye pressure go up a few weeks after tube shunt surgery?
This is a recognized pattern called the hypertensive phase. EyeWiki describes it as elevated pressure, typically in the 30 to 50 mm Hg range, occurring anywhere between 1 and 6 weeks after surgery, and says it is more common with valved implants such as the Ahmed than with non valved ones. It happens as a scar capsule forms around the plate. EyeWiki lists management as medical therapy, digital massage, bleb needling with or without 5 fluorouracil, or surgical revision of the capsule. Report a pressure rise to your surgeon and do not add or change drops on your own.
What is the difference between an Ahmed and a Baerveldt for recovery?
BrightFocus Foundation explains that the Ahmed is a valved device that limits flow in one direction, which puts a theoretical limit on how low the pressure can drop, so it carries a lower risk of the pressure being too low early on. The Baerveldt and Molteno are non valved, so they are tied off at surgery and the tube opens when the sutures dissolve or are removed approximately 4 to 6 weeks after surgery. EyeWiki adds that with valved implants the preoperative glaucoma medications are stopped, while with non valved implants they are continued until the capsule forms. BrightFocus Foundation also notes that in the ABC and AVB trials the Baerveldt gave greater pressure lowering but had more early and serious complications.
Will the tube or the patch over it be visible?
Sometimes, a little. EyeWiki says the tube is covered by a patch graft that can be processed pericardium, sclera, fascia lata, dura, or cornea, which can look like a slightly raised lighter or greyish patch on the white of the eye. The plate itself sits behind the eyelid and is not normally visible. BrightFocus Foundation notes the implant may occasionally work its way toward the surface of the eye and need repair or removal, and EyeWiki says tube erosion through the conjunctiva requires prompt surgical intervention to prevent endophthalmitis, so tell your surgeon if the area over the tube becomes red, sore, or looks like it is thinning.

Sources