Glaucoma treatment is undergoing a significant transformation. Traditionally, the therapy path followed a rigid progression from topical eye drops to invasive surgery. However, this 'step-ladder' approach often imposes a heavy physical and psychological burden on the patient. This review explores the emergence of next-generation pharmaceuticals and sustained-release systems as realistic alternatives to surgical intervention. The analysis focuses on three key areas: the development of dual-action molecules that restore physiological drainage, the introduction of biodegradable implants that ensure long-term stability, and the shift toward neuroprotective strategies. These advancements suggest that the potential of medical therapy is expanding, allowing for effective pressure control with fewer complications. While surgery remains essential for advanced cases, this work highlights a future where glaucoma can be addressed as a chronic condition through molecular precision, prioritizing the patient’s quality of life and long-term visual prognosis.