Glaucoma is a group of eye conditions that damage the optic nerve. This damage is frequently associated with elevated intraocular pressure (IOP), the fluid pressure inside the eye. While medical treatments are the foundation of management, patient behavior plays a significant part in preserving vision. Certain everyday activities, medications, and dietary habits can cause temporary or sustained increases in IOP, potentially accelerating damage to the optic nerve. Understanding these factors and knowing what to avoid is a crucial complement to your prescribed treatment plan.
Physical Activities That Elevate Eye Pressure
Any activity that causes the head to be positioned below the heart can lead to a rapid increase in intraocular pressure (IOP). This inverted posture causes blood and fluid to pool in the head, subsequently raising the pressure inside the eye. Certain yoga poses, such as the headstand or the downward-facing dog, can cause transient IOP elevations, sometimes spiking as high as 11 to 16 mmHg above baseline levels.
The use of an inversion table, often recommended for back pain, also creates this head-down effect and should be avoided by individuals with glaucoma. These temporary spikes in pressure are a concern for patients whose optic nerve is vulnerable to damage. Avoiding any extended period where the head is significantly lower than the heart helps stabilize eye pressure.
Strenuous physical effort, particularly heavy resistance training, can also elevate IOP due to the Valsalva maneuver. This maneuver involves forcefully exhaling against a closed airway, typically when lifting heavy weights, which dramatically increases central venous pressure and, consequently, eye pressure. Isometric exercises can cause an acute IOP rise of around 4 to 5 mmHg. Patients should focus on lower-weight, higher-repetition routines and remember to breathe continuously throughout the exercise to prevent pressure spikes.
A less obvious physical constraint involves restrictive garments around the neck. Wearing a necktie or a shirt collar that is too tight can impede blood flow from the head and constrict the jugular vein. This constriction interferes with venous return, which can lead to a measurable increase in intraocular pressure. It is prudent to ensure that neckwear is loose enough to allow easy blood flow.
Medications and Drug Classes to Discuss with a Doctor
A variety of non-glaucoma medications can inadvertently affect eye pressure and should always be discussed with your primary care physician and ophthalmologist. Corticosteroids, commonly used to treat inflammation and autoimmune conditions, represent one of the most significant pharmaceutical risks for elevated IOP. These drugs, sometimes called glucocorticoids, come in many forms, including oral tablets, nasal sprays, inhaled asthma medications, topical skin creams, and eye drops.
The risk is highest with topical eye drops, which can cause IOP to rise significantly in susceptible individuals, known as “steroid responders,” often within three to six weeks of use. Corticosteroids affect the trabecular meshwork, the eye’s drainage system, by reducing the outflow of aqueous humor. Even systemic forms, like oral or inhaled steroids, can cause ocular hypertension, and the risk is amplified in patients who have primary open-angle glaucoma or a family history of the disease.
Anticholinergic Drugs
Certain classes of drugs that possess anticholinergic properties also pose a serious risk, primarily for people with narrow-angle glaucoma. These medications work by blocking the action of acetylcholine, which can cause the pupil to dilate (mydriasis). Pupil dilation can physically block the drainage angle in the eye, leading to a sudden spike in IOP known as an acute angle-closure attack.
Common over-the-counter and prescription drugs with anticholinergic effects include some antihistamines, certain cold and flu medications, specific antidepressants like tricyclic antidepressants, and medications for an overactive bladder. Additionally, some sulfa-based drugs have been implicated in causing an idiosyncratic reaction that results in acute angle-closure glaucoma. Never discontinue a prescribed medication without speaking to the prescribing doctor, as they can often recommend an alternative treatment that is safer for your eyes.
Dietary Choices and Consumption Patterns to Limit
The speed and volume of fluid intake can have a direct, temporary impact on intraocular pressure. Rapidly drinking a large volume of liquid, such as a liter of water within a few minutes, can cause an acute, transient spike in IOP. This effect is due to rapid fluid absorption, which lowers the osmotic pressure of the blood and drives fluid into the eye. Studies have shown that this rapid intake can increase IOP by several millimeters of mercury, sometimes up to 6 mmHg, particularly in those with advanced glaucoma.
It is advisable to avoid chugging large quantities of water or other fluids, especially during specific medical procedures that require high fluid consumption. Instead, spread your hydration throughout the day by sipping water steadily to maintain a stable balance.
Moderate caffeine consumption, such as one or two cups of coffee daily, is considered safe for most glaucoma patients. However, high-dose caffeine intake, defined as roughly three or more cups of caffeinated coffee per day (over 300 mg), can cause a temporary spike in IOP, typically ranging from 1 to 4 mmHg, peaking about an hour after consumption. Excessive alcohol intake may also lead to pressure fluctuations or dehydration, which can influence eye health. Moderation is key with both caffeine and alcohol.