This was a prospective study carried out among patients with Primary open angle glaucoma at the Eye clinic of the National Hospital Abuja with the aim of determining the pattern of presentation of patients with Primary open angle glaucoma, the acceptability of surgery as primary treatment and the level of compliance with medical therapy. All glaucoma patients presenting for the first time in the hospital eye clinic between September 2011 and May 2012 with a diagnosis of primary open angle glaucoma were enrolled in the study. They were followed up for 3months. Data was obtained using interviewer administered questionnaires and ocular examination which included visual acuity, gonioscopy, slit lamp examination, funduscopy, tonometry, central corneal thickness measurement and visual fields. Data analysis was done using the Statistical Package for Social Sciences (SPSS) version 15. A total of 152 patients were seen in the eye clinic within the study period. The male to female ratio was 1.34:1. The mean age was 51.73yrs (SD ± 12.04) and the peak age incidence was in the sixth decade. The majority of patients, 109 (71.7%) had tertiary level of education while only 4.6% were illiterates. Eighty two patients (54%) had subjective visual loss at presentation. Twenty four (24) patients had visual impairment (15.8%) while 9 patients (5.9%) were blind at presentation. Twenty eight patients (18.4%) presented with cup to disc ratios of 0.9-1.0 while 29 patients (19.1%) had severe visual field defects. Seventy six patients (50%) accepted to have glaucoma surgery at initial presentation. Of the 76 who did not accept surgery, the major reasons given were fear of surgery in 39 patients (51.32%), and knowledge that there will be no visual improvement following the surgery in 18 patients i (23.68%). Male gender (P<0.01) and living outside Abuja (P<0.05) were significantly associated with acceptance of glaucoma surgery. The compliance rate with medical therapy was 71.8% while the default rate was found to be 28.2%. Forgetfulness in 60 patients (64.5%); high cost in 11 patients (11.8%) and inconvenience in 10 patients (10.8%) were the major causes of default. Tertiary level of education, higher occupational status, good knowledge of the disease, knowledge of the name of the eye condition (P<0.01) and early to moderate visual field defects (P<0.05) were significantly associated with good compliance. There is the need for adequate education of all glaucoma patients. Increased sensitization to glaucoma surgery, the use of memory aids and once daily dosing regimen will help overcome the problems of poor acceptance of surgery and poor compliance.