Tight Necktie May Boost Glaucoma Risk

Blood Pressure in Eye Increases With Snugness of Neckwear

From the WebMD Archives

July 28, 2003 -- Depending on your tastes, wearing neckties may be an assault to some folks' vision. According to a new study, wearing them too tightly may harm your own.

Researchers say that a too-tight necktie may increase the risk of glaucoma by boosting blood pressure inside the eyes to dangerous levels. Specifically, a tight necktie constricts neck veins and raises the pressure in the eyes. Glaucoma, which afflicts at least 3 million Americans and is the leading cause of blindness in the U.S., usually occurs when pressure in the eyes increases to dangerous levels.

In their study, published in the August issue of the British Journal of Ophthalmology, researchers noticed a small but significant increase in this intraocular pressure in men who wore tight neckties. The 40 men studied -- half of them glaucoma patients and the others with no obvious vision-threatening condition -- were observed under three scenarios. When their neckties were tightened for three minutes, intraocular pressure spiked in 60% of the glaucoma patients and 70% of the healthy men. There were no such increases when they loosened their ties for three minutes or while wearing open-collared shirts.

Loosen Up

Does this mean that neckwear will soon join a list of established risk factors for glaucoma that includes being older than age 40; of African-American, Irish, Russian, Japanese, Hispanic, or Scandinavian descent; or having diabetes, hypertension, poor vision, or a family history of glaucoma?

Maybe not, but it does suggest that when it comes to neckwear, tight isn't right -- at least when it comes to protecting your vision.

"No one says you have to strangle yourself," says study author Robert Ritch, MD, chief of glaucoma services and surgeon director at the New York Eye and Ear Infirmary. "If you can't get your finger in between your neck and your collar easily, it's too tight."

Ritch tells WebMD that he conducted the study with other New York researchers because he noticed that in his own patients -- especially those with thick necks -- their intraocular pressure would decrease when he had them loosen their neckties during an eye exam.

"I have been telling my patients for years that if they have glaucoma, they should not wear tight neckties." Still, although eye pressure increases can be noted after just a few minutes of a wearing a tight necktie, Ritch says that in all likelihood, it would have to be "frequent and prolonged" to likely make tight neckwear a real threat to vision.

Other experts not involved in Ritch's study say that while it duplicates what has long been known -- that a short-term boost in neck pressure produces a sudden and mild increase in eye pressure -- there's no reason to believe that neckties can cause glaucoma.

"Since the study lasted only three minutes, it is impossible to know how long it would take to return to the original eye pressure," says glaucoma specialist Harry A. Quigley, MD, of the Wilmer Eye Institute at Johns Hopkins School of Medicine.

"This research does not present any real evidence that this factor increases risk of glaucoma," he tells WebMD. "It is simply common sense not to wear collars that are so tight that they cut off blood return from the brain. How many men tie their ties to the point of discomfort and leave them that way for prolonged periods?"

Steven J. Gedde, MD, of Bascom Palmer Eye Institute, praised the study -- and its research team -- for reminding ophthalmologists that a tight necktie may be along the other "external" factors, such as holding one's breath or having the hiccups, which can temporarily raise intraocular pressure and possibly produce false readings.

"When I measure someone's intraocular pressure, I tell patients not to hold their breath because we know that can cause a (short-term) rise in intraocular pressure. And that could influence how these levels are read and the decided course of treatment," Gedde says. "Wearing a necktie seems to fall under that same category."

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SOURCES: British Journal of Ophthalmology, August 2003. Robert Ritch, MD, professor of clinical ophthalmology, chief of glaucoma service, and surgeon director, the New York Eye and Ear Infirmary; founder and medical director, The Glaucoma Foundation, New York . Harry A. Quigley, MD, A. Edward Maumenee Professor of Ophthalmology and director, Glaucoma Service and Dana Center for Preventive Ophthalmology, the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore. Steven J. Gedde, MD, associate professor of ophthalmology, Bascom Palmer Eye Institute, the University of Miami School of Medicine, Miami, Fla.
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