The core pathological process of optic neuropathy caused by glaucoma is the progressive loss of retinal ganglion cells(RGCs). As the primary glial cells in the retina, Müller glial cells play a crucial and complex dual regulatory role in the pathological microenvironment of glaucoma. On one hand, Müller cells can exert endogenous protective effects by secreting neurotrophic factors, enhancing RGC viability through co-culture, and regulating glutamate metabolism. On the other hand, under sustained stress such as elevated intraocular pressure, Müller cells are activated by mechanosensitive channels(e.g., TRPV4), transforming into a reactive gliosis phenotype. This leads to the release of inflammatory cytokines that exacerbate RGC apoptosis, while their metabolic reprogramming and epigenetic alterations also contribute to the process of neuronal injury. This article systematically reviews the research progress on the dual roles of Müller cells in protecting and damaging the optic nerve in glaucoma, exploring new therapeutic strategies for neuroprotection by regulating their cellular states. It outlines the main controversies and unresolved issues in this field and, based on the latest research advances, analyzes the implications of targeting Müller cells for current clinical treatments and future development trends.

甘肃省卫生健康行业科研项目(No.GSWSKY2024-27); 甘肃省自然科学基金项目(No.25JRRA422); 联勤保障部队第九四○医院基金项目(No.2023YXKY025)