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Editors Selection IGR 9-3

Clinical examination methods: Tight neckties and IOP

Comment by Robert Ritch on:

13205 Does extended wear of a tight necktie cause raised intraocular pressure?, Talty P; O'Brien PD, Journal of Glaucoma, 2005; 14: 508-510

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We had earlier reported¹ in a prospective, observer-masked, controlled study that wearing a tight necktie for three minutes led to a mean elevation of IOP in normals of 2.6 &plm; 3.9 mmHg (P = 0.008; range -3 to +14 mmHg) and in glaucoma patients of 1.0 &plm; 1.8 mmHg (P = 0.02; range -2 to +4.5 mmHg), and that loosening the necktie allowed the IOP to return to baseline levels. We had suggested then that jugular vein compression might cause an increase in episcleral venous pressure which in turn could lead to an increased IOP.

Talty and O'Brien (856) hypothesized that tight necktie wear for an extended period of time might result in an autoregulatory response, which might then result in a return of IOP to baseline levels while the necktie was still tight. They measured IOP in both normals and glaucoma patients after tightening their neckties for three minutes and 15 minutes. They found a significant increase at three minutes only in the glaucoma group and in both groups IOP had returned to baseline after 15 minutes. They concluded that a tight necktie worn over an extended period is therefore neither a confounder to IOP measurement nor a factor leading to erroneous diagnosis of glaucoma and that avoidance of wearing a tight necktie over an extended period is not necessary in patients with glaucoma.

What had initially prompted our study was the finding that some patients, particularly those 'beefy' patients with florid complexions, who were wearing tight neckties and tight collars and who had IOPs in the low to mid-twenties, had reductions of IOP as much as six mmHg after loosening their ties and collars. These patients had been wearing tight neckties for a number of hours before being examined. Thus, it would seem that some patients do have sustained IOP rises under these conditions that may serve to be a confounder in measuring IOP, and could potentially adversely affect their condition. From a practical point of view, irregardless of the mean findings in groups of subjects, it would seem that having glaucoma patients not wear uncomfortably tight neckties would serve to obviate the entire issue.

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