Complicated glaucomas are always associated with diagnostic and treatment challenges. The purpose of this article is to discuss the causes and management of intractable glaucoma. The criteria that best defines intractable glaucoma is the inability to control the intra ocular pressure and optic neuropathy progression with the maximum tolerared medical therapy, filtering surgery or combination of both. The more the risk factors, there is greater likelyhood that the glaucoma will evolve rapidly to refractory glaucoma. Traditional filtering surgery becomes obsolete in most of these cases. Surgical outcome can be enhanced with the use of antimetabolites but they have increased rates of post operative complications. Glaucoma drainage devices can be a better choice in the initial phases of refractory glaucoma but long term results are unrewarding. Non penetrating surgery gives better outcome. Sub conjunctival implantation of XEN gel stent gives a better scope in the management of refractory glaucoma.
