In view of the aging members of our society, there will be an increase in severe visual impairment and blindness, also due to glaucoma, in the coming years. Therapy options are limited to treat occurring symptoms. Currently, only a deceleration of the pathogenesis progression, but no cure, is available. Therefore, it is necessary to develop new therapeutic strategies to treat glaucoma adequately and effectively, thus improving the quality of life of those affected. One possible approach seems to be primary neuroprotection, which acts independently of an intraocular pressure reduction. There are indications that components of the immune system play a role in the context of the disease or the loss of retinal ganglion cells. Thus, evidence of an involvement of heat shock proteins, the complement system, but also, for example, microglial cells, were found. To this end, therapeutic modulation of these factors seems to be an interesting new target for neuroprotection. Studies in animal models have shown that an inhibition of the complement system or microglia leads to a protection. Modulation of heat shock proteins may enhance their protective properties or inhibit their destroying function to prevent glaucoma damage. These neuroprotective substances could expand the treatment options of glaucoma patients in the future.Georg Thieme Verlag KG Stuttgart · New York.