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Purpose: To evaluate whether patients who have undergone trabeculectomy with mitomycin C have a different intraocular pressure (IOP) response profile after the water drinking test (WDT) from that of patients who are medically managed with a similar baseline IOP and level of visual field (VF) damage. Design: Prospective observational study. Participants: Thirty glaucoma patients with IOP controlled by trabeculectomy and 30 with medically treated glaucoma matched for level of VF damage and IOP at baseline (7–14 mmHg). Methods: All patients underwent the WDT, which involved drinking 1000 ml of water in 15 minutes. Main Outcome Measures: The IOP was measured before the WDT and subsequently at 15-minute intervals for 1 hour. The peak IOP with the WDT was compared between both groups using Tukey post hoc multiple comparison and paired t tests. Results: Baseline IOPs were 10.4±2.3 mmHg in surgically treated and 11.1±1.8 mmHg (P = 0.07) in medically treated eyes. After the WDT, mean IOPs in the surgically and medically treated groups were 10.7±2.3 mmHg and 14.6±2.2 mmHg. Mean maximum IOPs were 11.7±2.6 mmHg and 17.3±2.7 mmHg in the surgically and medically treated groups, respectively (P<0.0001), increases of 12.5% and 56%. Ranges of IOP during the WDT were 2.2±1.3 mmHg and 5.6±1.9 mmHg in the surgically and medically treated patients (P<0.0001). Conclusions: Patients with advanced glaucoma who are medically controlled show greater IOP elevation and peak IOP after the WDT than eyes that have undergone trabeculectomy. Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article. [Copyright &y& Elsevier]