Glaucoma is a group of eye conditions that cause progressive damage to the optic nerve, which transmits visual information from the eye to the brain. This damage is often associated with elevated fluid pressure inside the eye, known as intraocular pressure (IOP). The condition is frequently called the “silent thief of sight” because it typically progresses without noticeable symptoms until significant and irreversible vision loss has occurred. Protecting the optic nerve requires maintaining stable eye pressure by avoiding common activities and habits that can cause temporary but harmful pressure spikes.
Physical Activities That Spike Intraocular Pressure
Activities involving inverted body positions cause an acute rise in eye pressure. When the head is below the heart, gravity causes blood and fluid to pool, increasing pressure within the eye. Inverted yoga poses like headstands, shoulder stands, or the plow position should be avoided entirely, as they can increase IOP by 6 to 11 mmHg. Even the common downward-facing dog pose is generally discouraged.
Any activity requiring forceful straining or breath-holding, known as the Valsalva maneuver, creates a sharp pressure spike. This maneuver increases pressure in the chest and abdomen, reducing blood return from the head and causing pressure to back up into the eye. Heavy weightlifting, particularly compound movements like squats or deadlifts, is problematic if the breath is held. Studies show heavy leg presses performed with breath-holding can result in mean IOP spikes of 26.5 mmHg.
Playing high-resistance wind instruments, such as the trumpet or bagpipes, can also trigger the Valsalva effect due to the sustained, forceful exhalation required. While moderate aerobic exercise is beneficial, high-impact activities should be approached with caution or avoided. This includes activities involving constant jarring, such as boxing or intense trampoline jumping.
Lifestyle Habits Affecting Ocular Blood Flow
Chronic habits related to body positioning, especially during sleep, can affect eye pressure over many hours. Lying flat causes a postural increase in intraocular pressure (IOP) compared to sitting upright. Sleeping with the head elevated at a 30-degree angle can lower nocturnal IOP by an average of 3.2 mmHg. Patients who consistently sleep with their face pressed into a pillow, or on the side of the eye with more severe glaucoma, risk mechanical pressure that contributes to disease progression.
Wearing tight clothing around the neck, such as neckties or restrictive collars, can impede blood flow through the jugular veins. This venous constriction causes blood pressure to rise in the head and within the eye. Research has shown that a tight necktie can immediately increase IOP by 1.0 to 2.6 mmHg in glaucoma patients.
Eye rubbing can cause extreme and brief pressure spikes that may damage the optic nerve over time. Vigorous rubbing can elevate IOP to dangerous levels, with some studies recording peaks as high as 310 mmHg. This mechanical trauma is linked to progressive optic neuropathy. Tight swimming goggles that press directly into the eye socket should also be avoided, as they exert direct pressure on the globe and can raise IOP acutely.
Substances and Medications That Raise Eye Pressure
Certain pharmacological agents and common stimulants can negatively impact eye pressure and should be discussed with an eye care specialist.
Corticosteroids
Corticosteroids are the most significant medication concern, as they can cause a substantial rise in IOP, leading to steroid-induced glaucoma. Topical steroid drops pose the highest risk, but even inhaled, oral, or nasal steroids used for conditions like asthma or allergies can elevate eye pressure in susceptible individuals (“steroid responders”). For those with glaucoma, an IOP increase of 6 to 15 mmHg is possible with steroid use.
Stimulants and Smoking
Stimulants like caffeine can cause a small, transient increase in eye pressure, particularly in patients already diagnosed with glaucoma. While a single cup of coffee may not be harmful, high consumption (more than four cups daily) is associated with a higher risk of elevated IOP in people with a genetic predisposition. Smoking is also associated with higher mean intraocular pressure and nicotine can negatively affect ocular blood flow dynamics.
Over-the-Counter Medications
Over-the-counter cold and allergy remedies containing decongestants or antihistamines should be used with caution, especially for those with narrow-angle glaucoma. These medications can cause the pupil to dilate, which may physically block the eye’s drainage angle. This blockage can trigger a sudden, sight-threatening acute angle-closure attack. Patients should always consult their ophthalmologist before beginning any new course of medication.
Skipping Treatment or Monitoring
The most detrimental action a glaucoma patient can take is failing to adhere to the prescribed treatment plan. Since glaucoma is an asymptomatic chronic disease in its early stages, many patients lapse in the consistent use of their hypotensive eye drops, with adherence rates often falling to 50% or less. This non-adherence leads to sustained periods of uncontrolled eye pressure, the primary driver of optic nerve damage.
Poor adherence is directly correlated with disease progression; patients with adherence rates below 50% are significantly more likely to experience visual field deterioration. Forgetting to use drops, poor instillation technique, or running out of medication all expose the optic nerve to damaging pressure levels.
Missing regular follow-up appointments is equally damaging because the condition can worsen silently. Glaucoma requires consistent monitoring of eye pressure, optic nerve health, and visual field changes to ensure the treatment is effective. Patients who are “lost to follow-up”—going a year or more without seeing their eye doctor—often experience significant disease progression upon their return. Consistent treatment and monitoring are the most important behaviors to prevent irreversible vision loss.