My recent trabeculectomy has a very large bleb. Should my surgeon make it smaller, or will it get smaller in time on its own?
Usually aqueous fluid filtering through the hole in the sclera created by a recent trabeculectomy spreads out over a large area under the conjunctiva. This creates the bleb. Over time, the body constricts the bleb with scar tissue so that it becomes more localized to the area right over the original surgery. The pressure of the aqueous coming out of the eye is concentrated on a smaller area of conjunctiva, often thinning it, occasionally to the point that holes form in the conjunctiva and aqueous leaks out into the tears. Large blebs are preferable to small blebs because the fluid pressure is spread out over a larger area and there is less thinning of the conjunctiva. Therefore, unless a bleb is unsightly or uncomfortable, we usually leave it alone. Trying to reduce its size may reduce its effectiveness at lowering IOP. Dr.
