Abstract: The glymphatic system was firstly proposed in the central nervous system, and then has been proved to function as an eye scavenger of metabolic waste and neurotoxic substances. Recent studies have shown that the dysfunction of glymphatic system can aggravate the retinal deposition of amyloid β-protein (Aβ) in glaucoma. The abnormal changes of the mechanical environment in optic nerve and lamina cribrosa could interfere the function of glymphatic system, further leading to the block of axoplasmic transport and the obstacle of metabolic clearance in lamina cribrosa. The mechanical environment is firmly related to the structure of lamina cribrosa, lamina cribrosa deformation and defect can significantly affect the clearance efficiency of neurotoxic substances through glymphatic system. The advent of glymphatic system helps to rethink the mechanism of optic nerve damage in normal-tension glaucoma and advanced glaucoma from a new perspective. (Int Rev Ophthalmol, 2022, 46: 193-199)

Key words: glaucoma, glymphatic system, waste removal, amyloid β-protein (Aβ), trans-lamina cribrosa pressure difference