Does sleeping on your stomach increase intraocular pressure? Sleeping posture, glaucoma risk, and eye care strategies.

Many people are accustomed to sleeping face down, or even lying face down on their desks during lunch breaks. There's a common belief that sleeping face down increases intraocular pressure, significantly raising the risk of glaucoma, especially for people with high blood pressure, high cholesterol, or high blood sugar. It's also said that research has found...Sleeping on your stomach can cause intraocular pressure to rise by about 1401 T/4.Sleeping face down for 6 to 8 hours a day greatly increases the chances of vision damage.

This direction isn't without basis—sleeping posture does indeed affect intraocular pressure, and intraocular pressure is indeed a controllable risk factor for glaucoma. But the most alarming number...It needs to be restored to its original weight.The "140%" figure is not the average increase for most people, but rather comes from a specific...Patients with specific eye diseasesThe study, and it is the study in whichUpper limit of the range of individual cases' increasesThis is not an average. At the same time, the popular advice to "elevate your head with a pillow" has also been contradicted by recent studies.

This article reorganizes the relationship between sleeping posture and intraocular pressure based on actual measurement data, supplements local glaucoma data in Hong Kong, the correct description of the normal range of intraocular pressure, the most important concept that "high intraocular pressure does not equal glaucoma", and the current treatment options of drugs, lasers and surgery.

1. How did the claim that "sleeping face down causes intraocular pressure to rise by 1401 TP4T" come about?

First, let me state the source. This statement originates from an interview with local media.Ophthalmologist Qiu JunyuanThe report covered the causes of intraocular pressure, the origins of sleeping face down, the metaphor of glaucoma as a "vision thief," and four types of glaucoma surgery. The report was later rewritten as a popular science article and circulated online; an earlier article on this site also originated from the same source.

The part of the report related to numbers is this sentence:"Studies have found that sleeping on your stomach can raise intraocular pressure by about 1401 TP4T above normal. If you sleep on your stomach for 6 to 8 hours a day, the chance of vision damage will be greatly increased."The following items will be checked one by one.

The true nature of "140%": It is neither the average nor belongs to the average healthy person.

Reviewing the literature,142% This figure comes from a 2018 study published in *Clinical Ophthalmology*. The study's key points are as follows:

project	content
Research subjects	24 patients with pigmentary dispersion (PD) or suspected glaucomaA total of 44 eyes—not those of a typical healthy person.
Measurement method	First, measure in a seated position, then measure in four different lying positions, and measure again each time you return to a seated position.
Key findings	Intraocular pressure is higher in all four lying positions than in the sitting position;The increase in intraocular pressure is significantly greater when lying prone than when lying on one's side.There was no significant difference between the dependent and non-dependent sides.
Range of increases	-4 to +17 mmHg, which translates to -17% to +142%.
distributed	Eyes with 64% should increase to at least 33%, and eyes with 43% should increase to 50% or more.
The author suggests	These types of patients may be consideredRaise the head of the bed to about 30 degrees.Sleep patterns

in other words,"142%" is the upper limit of the interval in this study (i.e., the eye with the largest increase), not the average of the whole group, nor is it "the average person would increase to 140% when sleeping face down".The study's conclusions also clearly defined the subjects as patients with pigment dissemination-related conditions.

What is the actual increase in the rate of improvement for a generally healthy person?

So how much does postural intraocular pressure change in the average person? A 2024 study involving 62 healthy subjects and 124 eyes measured intraocular pressure using a portable tonometer in standing, sitting, supine, and prone positions, and obtained the following results:

Posture comparison	Mean difference in intraocular pressure
Sitting posture → Supine	+1.30 mmHg
Supine → Prone	+2.24 mmHg
Sitting posture → Lying prone	+3.22 mmHg
Sitting posture → Standing for 5 minutes	+0.53 mmHg
Standing → Sitting	-0.13 mmHg (not statistically significant)

Therefore, for healthy people,The blood pressure is approximately 3 mmHg higher when prone than when sitting and approximately 2 mmHg higher when supine.This represents a "real but limited" change. The same study also indicated that the change in intraocular pressure during the 5-minute interval between standing and sitting may be valuable for explaining some patients whose "intraocular pressure appears normal"—which corresponds to the normal-tension glaucoma discussed later.

Prolonged prone position during surgery: The increase in elevation will be cumulative.

If the posture is maintained for a long time, the rise will be more than 3 mmHg. The most complete data in this regard comes from studies involving spinal surgery and other procedures requiring prolonged prone general anesthesia.

• A meta-analysis of nine studies involving 229 adults showed that the rate of anesthesia induction to...Within 10 minutes of lying prone, intraocular pressure increased by an average of approximately 7.5 mmHg.;afterContinue rising until the prone position ends, with a cumulative average increase of approximately 10.1 mmHg.。
• Another systematic review covering 8 studies and 649 patients also confirmed that intraocular pressure increased significantly when changing from a supine to a prone position, and recorded 3 patients experiencing visual disturbances after surgery, but none of them went blind.

These studies also list several specific measures that can mitigate the rise, including: takingReverse Trendelenburg (head higher than feet) 5 to 10 degreesprone position,shorten the time spent lying face down、Change your posture regularly or schedule rest periods.、Avoid direct pressure on the eyeballAnd monitoring intraocular pressure. These practices all point to the same message:The key points when lying prone are to "avoid pressure on the eyeballs" and "avoid maintaining the position for too long".。

II. What is intraocular pressure? Normal range and the fact that "high intraocular pressure ≠ glaucoma"

Intraocular pressure (IOP) is the pressure inside the eyeball, which helps maintain the shape and normal function of the eye. There is a pressure system inside the eyeball called...AqueousThe clear fluid inside the eye is continuously secreted by the ciliary body and drained through the anterior chamber angle (drainage channel) between the cornea and iris. When secretion and drainage are balanced, intraocular pressure remains stable; once drainage is obstructed or excessive secretion occurs, aqueous humor accumulates, and intraocular pressure rises.

Limitations of normal intraocular pressure range and measurement

Generally10 to 21 mmHg (millimeters of mercury)This serves as a reference range for intraocular pressure in adults. Several points must be noted:

• These are reference values, not diagnostic lines.The measuring instrument, corneal thickness, and measurement time all affect the reading. People with thicker corneas tend to have higher readings, while people with thinner corneas (such as those who have undergone laser vision correction) tend to have lower readings.
• Intraocular pressure is not a fixed value.Its frequency varies depending on factors such as posture (see Section 3), time of day/night, drinking large amounts of water in a short period, and wearing tight-fitting clothing. Clinically, this will be considered...24-hour intraocular pressure fluctuationGenerally, a fluctuation of less than 8 mmHg is used as a reference; even if a single outpatient measurement is normal, it does not mean that the measurement is normal for the whole day.
• There can naturally be a difference in intraocular pressure between the two eyes.Generally, it is within 5 mmHg.

High intraocular pressure does not equal glaucoma—this is the most important point.

Many people believe that high intraocular pressure is the same as glaucoma. According to data from the Department of Ophthalmology and Visual Sciences at the Chinese University of Hong Kong,This is a common misconception.The following are three concepts that must be understood separately:

Condition	intraocular pressure	Optic nerve and visual field	illustrate
ocular hypertension	Higher than the reference range	No glaucomatous damage was observed.	These are risk factors; some cases may develop glaucoma later in life, requiring regular monitoring.
glaucoma	Most are too high, butIt can work normally	Optic nerve damage and visual field defects have occurred.	Intraocular pressure is a major risk factor, but not the only one.
Normal-tension glaucoma	Between 10 and 21 mmHg	Glaucoma still has optic nerve damage	Asians are relatively common and it is difficult to detect.

Information from Zhongda Eye Hospital mentions thatGlaucoma patients with intraocular pressure as high as 501 TP4T have "normal" or even low intraocular pressure."High intraocular pressure" is no longer part of the definition of glaucoma. Therefore, measuring intraocular pressure alone is insufficient to diagnose glaucoma; it must be combined with optic nerve and visual field examinations. Conversely, measuring intraocular pressure remains important—because...Intraocular pressure is currently the only confirmed and controllable risk factor for glaucoma.Lowering intraocular pressure is currently the only treatment with evidence showing that it can stop or slow the progression of the disease.

For basic concepts about intraocular pressure and vision, there is another article on this site discussing the effects of prolonged use of electronic devices on the eyes; you can read more there.Prolonged use of blue light filtering products can damage the eyes.>and<6 ways to protect your eyes: Daily strategies for dealing with prolonged screen time, dry eyes, and vision deterioration〉。

III. Sleeping Posture and Eye Pressure: Actual Differences and the Negative Effects of High Pillows

Actual differences in supine, lateral, and prone positions

A person spends about one-third of their sleep time in a horizontal position, and intraocular pressure is generally higher at night and in the early morning. Combining the data from the second section with that from the first section provides a clear comparison:

sleeping position	Changes in intraocular pressure relative to sitting posture	Remark
Lie on your back (flat-back)	Approximately +1.3 mmHg	The position with the smallest elevation is the most commonly recommended sleeping position.
Side-lying	The increase was larger on the dependent side (the side in contact with the bed) and smaller on the non-dependent side; the difference was generally within 2 mmHg.	About one-third of people are accustomed to sleeping on their side, with sleeping on the right side being the most common.
prone	Approximately +2.2 mmHg (relative to supine position); +3.2 mmHg (relative to sitting position)	Of the four postures, this one causes the greatest increase in pressure and is most likely to compress the eyeballs.

It needs to be emphasized that:These differences will continue to change throughout the night.People typically change positions multiple times throughout the night. Current evidence suggests that sleeping position affects intraocular pressure.Measurable short-term impactHowever, sleeping posture and glaucomaLong-term deteriorationThe relationship betweenNot established—A 2019 review noted that while some studies have observed that postural elevation may persist and is associated with worsening of the eye-dependent aspect,Multiple studies failed to find a strong correlation.。

Asymmetry between side sleeping and glaucoma

A rather interesting finding is that "which side you sleep on" may have an impact. A study of 54 patients with primary open-angle glaucoma used sleep lab recordings of their sleeping positions, and then had 29 patients with low intraocular pressure recorded their sleeping positions for two consecutive nights at home. The results showed:

• On average, patients spend about 191 TP4T of time sleeping on the same side.Sleeping on the right side is more common。
• Sleeping on your right side andPoor visual field in the left eyeRelatedly, the symmetry score of the retinal nerve fiber layer was also worse in right-handed sleepers.
• In the expanded sample (178 patients) questionnaire survey, 73% low intraocular pressure patients and 58% high intraocular pressure patients had asymmetrical sleeping positions.

This is an observational correlation, not a causal proof, and it does not mean that "sleeping on different sides can cure glaucoma." However, for people who have already been diagnosed with glaucoma and whose condition is significantly asymmetrical, this finding is worth discussing—it is worth bringing up with an ophthalmologist during follow-up appointments.

Why using a pillow to elevate your head might actually do more harm than good.

The original suggestion was to "properly support your head with a pillow to avoid direct pressure on your eyes." The first part, "avoid pressure on the eyes," is entirely correct, but...The practice of "elevating the head" has been questioned in recent years.。

A 2026 study published in the *British Journal of Ophthalmology*, which included 144 glaucoma patients, compared...supine position與High pillow positionThe results regarding intraocular pressure (when the head is elevated 20 to 35 degrees using two pillows) are quite clear:

• Compared to lying on your back,Intraocular pressure increased significantly, 24-hour intraocular pressure fluctuation increased, and intraocular perfusion pressure decreased when the head was in a high-pillow position.(All p < 0.001).
• The study also examined 20 healthy volunteers with ultrasound, finding that the elevated pillow position...The lumens of both the internal and external jugular veins are significantly narrowed.The highest blood flow velocity in the internal jugular vein increased (p = 0.013).
• The author's explanation is:Elevating the head causes neck flexion, compresses the jugular vein, obstructs venous return, and consequently increases intraocular pressure.The conclusion recommends that glaucoma patients avoid sleeping positions that could compress the jugular vein.

This finding contradicts earlier claims that "elevating the head of the bed helps reduce postural elevation." The difference lies in the methods used:Elevate the pillows to make your head bend forward.,andTilt and raise the headboard section of the entire bed (while keeping your body straight).The effects on the jugular vein vary. Current evidence is insufficient to definitively say which approach is best, therefore this section does not offer a single recommendation.

So how should we sleep?

Taking all the above research into account, the more plausible practical direction is:

• Avoid direct pressure on the eyeball—This is the most accurate sentence in the original manuscript. Sleeping face down with your eyeballs pressed down results in the greatest increase in eyeball height and should be avoided.
• Avoid keeping your neck in an overly flexed position for extended periods.This includes using pillows that are too high or too hard to elevate the head.
• There's no need to forcibly change your usual side-sleeping position in order to "prevent glaucoma".However, if glaucoma has been diagnosed, you can tell your doctor your sleeping position and direction during your follow-up visit so that they can evaluate it together.
• If you are at high risk for glaucoma or have a family history of glaucoma.Have a complete eye exam first.This is more meaningful than figuring out "which sleeping position is the safest" on your own.

IV. Glaucoma: Hong Kong's leading cause of blindness

Glaucoma is a group of...optic nerve and retinal nerve fiber damageRelated eye diseases. If left untreated, peripheral vision will gradually be lost, the field of vision will narrow like a tunnel, and eventually permanent blindness may result.

Open-angle and closed-angle

type	mechanism	Performance	Remark
Open angle type	The anterior chamber corner remains open, but the drainage of the trabecular mesh is obstructed, resulting in slow drainage of aqueous humor.	It is usually asymptomatic; peripheral vision is affected first, and then gradually spreads to the central vision.	Most common, accounting for about 80% of the total.
Closed angle(acute)	When the iris bulges forward, the anterior chamber angle narrows or becomes blocked, preventing aqueous humor from draining.	Severe eye pain, throbbing pain, nausea, vomiting, headache, blurred vision, seeing rainbow halos around lights, red eyes	Ophthalmic emergencyIt can deteriorate rapidly within hours.
Closed angle(Chronic)	Same as above, but the corners gradually narrow.	The symptoms are not obvious, but in the later stages, vision loss and visual field defects appear.	Relatively common among East Asians

The incidence of angle-closure glaucoma is higher in populations in Taiwan and other parts of Asia. Local ophthalmological organizations point out that...Acute angle-closure glaucoma is the most common type of glaucoma among people of East Asian descent, accounting for nearly 60% of cases worldwide.In addition, both open-angle and closed-angle glaucoma can be further divided into primary and secondary types. Secondary glaucoma can be caused by eye injury, uveitis, tumors, advanced cataracts, diabetes, or long-term use of corticosteroids.

"The Eye Thief": Why is it not noticeable at first?

The original text refers to glaucoma as a "vision thief," a metaphor widely used in the local medical community that aptly illustrates its danger.Early-stage glaucoma initially impairs peripheral vision, but the visual fields of both eyes complement each other, leaving central vision unaffected.Therefore, patients may not be able to detect the abnormality. By the time the visual field narrows to the point of affecting central vision, or when patients feel that "the range of vision has narrowed," the optic nerve damage is often already quite significant.

This is why "waiting for symptoms before getting checked" is insufficient—the original text correctly points out that elevated intraocular pressure usually occurs without any noticeable symptoms, a point worth retaining. Another older article on this site discusses the common trigger of prolonged mobile phone use in dark environments; further reading is available at <<Playing mobile phones without lights for a long time may cause glaucoma overnight.〉。

Hong Kong local data

• According to the Hospital Authority,In Hong Kong, approximately 3 out of every 100 residents aged 40 and above suffer from glaucoma.。
• Local data shows thatThere are approximately 120,000 glaucoma patients in Hong Kong, of whom about one-seven suffer from blindness.Glaucoma is a disease in Hong Kong.Number one cause of blindnessApproximately 100 local cases of blindness23%It is related to glaucoma.
• Globally, the prevalence of glaucoma in people aged 40 to 80 is approximately... 3.54%The number of patients is estimated to increase from 76 million in 2020 to [a number missing] in 2040. 111.8 millionThe growth rates in Asia and Africa were particularly significant.

It should be noted that the figures such as "120,000 patients" and "one in seven are blind in both eyes" come from publicly available data from the local ophthalmology community, while "about 3 out of every 100 patients over 40 years old" are from data from the Hospital Authority. The two figures are based on different statistical bases and years, and should not be directly added or compared.

V. Who are at high risk? The relationship between "three highs" (high blood pressure, high blood sugar, and high cholesterol) and glaucoma.

The original manuscript specifically reminded people with high blood pressure, high cholesterol, and high blood sugar to pay attention, as there is literature to support this direction, but it needs to be stated more precisely.

Metabolic syndrome, hypertension and diabetes

A meta-analysis published in 2024, which included nine observational studies and a total of 2,258,797 participants, showed that:Metabolic syndrome is associated with an increased risk of glaucoma (odds ratio OR 1.34, 95% confidence interval 1.15– 1.55).More noteworthy are the sub-results:

• High blood pressure and high blood sugarThe association with glaucoma is statistically significant.
• Obesity and dyslipidemia則Not statistically significant。

In other words, among the "three highs"The evidence linking blood pressure and blood sugar to glaucoma is relatively clear, while the evidence for blood lipids is weaker.Local ophthalmology data also lists hypertension and diabetes as risk factors for glaucoma, as well as related diseases such as secondary glaucoma (e.g., neovascularization caused by diabetes leading to the growth of new blood vessels into the anterior chamber angle).

Another easily overlooked but important reminder: while people with high blood pressure are more prone to glaucoma,Glaucoma patients should try to avoid low blood pressure.Because low blood pressure reduces blood flow to the optic nerve, it can worsen glaucoma. Therefore, blood pressure management should be based on a comprehensive assessment by a doctor and should not be drastically adjusted on one's own.

Sleep apnea: A frequently overlooked high-risk factor

This point was not mentioned in the original manuscript, but the evidence is quite consistent. Both meta-analyses show an association between obstructive sleep apnea and glaucoma:

• A meta-analysis including six studies and over 2.28 million participants yielded an adjusted odds ratio for case-control studies of [missing information]. 2.46(95% CI 1.32–4.59), generational study for 1.43(95% CI 1.21–1.69).
• According to data from the Chinese University of Hong Kong's ophthalmology department, approximately 100,000 people in Hong Kong suffer from sleep apnea.Patients with severe glaucoma have a two to three times higher chance of developing glaucoma than the general population.。

Glaucoma screening is worth considering for people with severe snoring, frequent daytime drowsiness, or those diagnosed with sleep apnea.

Other risk factors at a glance

category	factor
Unchangeable	People over 40 years of age (risk increases with age), those with a blood relative who has had glaucoma (the chance of developing the disease is about six times higher for immediate family members), and those of Asian ethnicity (Asians are more prone to angle-closure and normal-tension glaucoma).
Eye conditions	Severe myopia or severe hyperopia, thin central cornea, narrow anterior chamber angle, and high intraocular pressure
Systemic diseases	Hypertension, diabetes, metabolic syndrome, cardiovascular disease, sleep apnea, migraine
Drugs and other	Long-term use of steroids(Eye drops, ointments, or oral medications may be used), smoking, history of eye injury

"Long-term use of steroids" deserves special mention, as it is the easiest to overlook. Local ophthalmologists warn that steroids are a common but insidious cause of glaucoma, and long-term use, whether in eye drops, ointments, or oral medications, can lead to increased intraocular pressure.

VI. When to Seek Medical Attention: Examination Items and Warning Signs

What does an eye exam involve?

Glaucoma can occur even with normal intraocular pressure; a complete evaluation requires multiple tests.

Inspection items	Purpose
Intraocular pressure measurement (tonometer)	Measuring intraocular pressure is currently the only controllable risk factor.
Optic nerve examination (fundus examination)	Observe whether the optic disc is concave, enlarged, or pale, a typical feature of glaucoma.
Visual field test	Assess the extent of optic nerve function impairment and identify blind spots or visual field defects.
Optical coherence tomography (OCT)	Precisely measure the thickness of the retinal nerve fiber layer;Thinning of the nerve fiber layer is often the earliest sign before visual field defects appear.
Gonioscopy	Directly observe whether the anterior chamber angle is open or closed to distinguish between open-angle and closed-angle anterior chamber types.
Corneal thickness measurement	Corneal thickness affects the accuracy of intraocular pressure readings.

It is recommended to check age and frequency.

The general recommendation from the local ophthalmology community is:People over 40 years of age should have their first comprehensive eye exam, and those with a family history of eye disease should have it earlier.After thatRe-examination every 1 to 2 yearsThe original text's statement that "people aged 40 and over should have regular eye health checkups" is correct, but "regularly" should be specified as every 1 to 2 years. In recent years, some local institutions have also developed technologies for earlier glaucoma detection; see the previous article on this site...New technology from PolyU helps patients detect glaucoma early.> It was previously introduced.

Acute angle-closure glaucoma is an ophthalmic emergency.

Local ophthalmology organizations also remind people of a useful seasonal information:Some antihistamines have anticholinergic effects, which may cause pupil dilation and increase the chance of an acute angle-closure glaucoma attack.If you are a high-risk individual (especially women, those over 50 years of age, those with farsightedness, narrow anterior chamber angle, or a family history of the disease), you should consult a doctor or pharmacist before taking cold medicine or anti-allergy medication.

Warning signs of chronic glaucoma

Chronic glaucoma may not present with severe symptoms, but there are still some warning signs to watch out for: significantly narrowed visual field, decreased peripheral vision, noticeable decline in vision in the dark, seeing halos around lights at night, a significant difference in vision between the two eyes, or unexplained and continuous worsening of myopia. In all these cases, an eye exam should be scheduled, rather than waiting for "more obvious" symptoms to appear.

VII. Glaucoma Treatment: Lowering Intraocular Pressure is Key

First, let's establish the most important premise. The Department of Health's Drug Office makes it very clear:Glaucoma cannot be cured, and the damage it causes cannot be reversed.However, early detection and appropriate treatment can prevent or delay further damage to vision. The CUHK Ophthalmology Department also points out that...Lowering intraocular pressure is, to date, the only treatment method with evidence showing that it can stop or slow disease progression.。

In other words, the goal of treatment isControl the disease and preserve existing visionIt's not about "reversing" lost vision. The original text's use of the phrase "reversing disease progression" needs to be corrected—this is precisely why we need to be vigilant about glaucoma: the earlier it's detected, the more vision can be preserved.

Eye drops: The most common first-line treatment

The function of eye drops isLower intraocular pressureThis is achieved through two pathways: "reducing aqueous humor production" or "increasing aqueous humor discharge." Common categories include:

• prostaglandin analogues—It increases the discharge of aqueous humor and is usually used once a night; common side effects include red eyes, longer eyelashes, and eyelid pigmentation.
• β-blockers—Reduce aqueous humor production.
• Carbonic anhydrase inhibitors及α2 adrenergic receptor agonists— Reduce aqueous humor production.
• Cholinergic drugs—Increases drainage of aqueous humor.

To clarify one point: eye dropsIt cannot "alleviate narrowed field of vision".—Lost visual field will not be restored. Its function is to delay or stop further visual field loss. In addition, eye drops need to...Use daily on timeTo achieve the best results, long-term use may cause dry, red eyes, or even drug sensitivity. Therefore, regular follow-up appointments are necessary for doctors to adjust the treatment plan. For more information on the relationship between eye drops and dry eyes, please read the following article on this website:Dry eye syndrome and prolonged screen time: How strong is the connection? How to choose artificial tears? When to seek medical attention?〉。

Laser treatment: Selective trabeculoplasty (SLT) can be used as a first-line treatment.

This is a significant development that was not mentioned in the original manuscript. The original manuscript listed lasers as a type of "surgery," but in reality, lasers are currently used in a wide range of clinical applications.First-line treatmentIt is listed alongside eye drops.

Known as LiGHT testA multicenter randomized controlled trial (718 patients with untreated open-angle glaucoma or ocular hypertension from 6 hospitals in the UK) compared "selective trabeculoplasty first" with "eye drops first," and the results were published in two phases:

Time point	Main results
3 years	Health-related quality of life in both groupsNo significant differenceThe laser group has 74.2% Patients did not need eye drops to maintain target intraocular pressure; the laser group achieved target intraocular pressure at more follow-up visits (93.01 TP4T vs 91.31 TP4T); patients requiring intraocular pressure-lowering surgery were... 0 people vs 11 people
6 years	There was no significant difference in quality of life; the laser groupThe glaucoma symptom scale score was better.Laser group 69.8% The eye can maintain the target intraocular pressure without medication or surgery; the eye drop group showed a higher incidence of disease progression.26.8% vs 19.6%Patients requiring trabeculectomy 32 eyes vs 13 eyesCataract surgery was also more commonly performed using eye drops (95 eyes vs. 57 eyes).No serious adverse events related to laser occurred.

The study authors concluded that selective trabeculoplasty is a safe and effective treatment, providing better long-term disease control than initial eye drop therapy and reducing the need for future incisional glaucoma and cataract surgeries. Therefore, this treatment...It can be used as a first-line treatment for open-angle glaucoma and ocular hypertension.The specific method used should be jointly decided with the ophthalmologist based on the patient's condition, lifestyle, and follow-up appointment schedule.

Other laser treatments include:Iris laser puncture(Drilling holes around the iris to balance the pressure in the anterior and posterior chambers and improve aqueous humor flow; commonly used for closed-angle iris lesions)Argon laser peripheral iridotomy(Contract the iris tissue and open the anterior chamber angle).

Surgical treatment: From traditional filtration surgery to minimally invasive surgery

If medication and laser treatment fail to control intraocular pressure, surgery will be considered. The original manuscript listed four types of surgery, which is generally correct, but one item needs to be updated.

category	illustrate
Trabeculectomy(Traditional filtration surgery)	A small hole is made in the eyeball to allow the aqueous humor to drain out through the bleb, thus relieving intraocular pressure. This method is effective in lowering intraocular pressure, but the procedure is complex, involves a larger wound, and has a longer recovery time.
Drainage device/catheter implantation surgery	A special catheter or drainage valve is implanted inside the eyeball to drain the aqueous humor to the outside of the eye. This is mainly suitable for cases where drainage surgery is ineffective or the condition is more complex; there are also implanted valve devices that automatically open to drain the fluid when the intraocular pressure is too high.
Minimally Invasive Glaucoma Surgery (MIGS)	With smaller incisions, lower invasiveness and risk, and shorter recovery time, it can be performed simultaneously with cataract surgery. Among them, the "non-filtering bubble" category (such as various types of iStent and Hydrus micro-stents) mainly targets the internal structure of the eyeball, using micro-devices to enhance natural drainage;The blood pressure reduction is generally lower than that of traditional surgery (approximately 10% to 20%, equivalent to the effect of a type of glaucoma eye drops).。
Destructive treatment of the ciliary body	It reduces the amount of aqueous humor produced by damaging the ciliary body tissue responsible for producing aqueous humor. It is mainly used for end-stage glaucoma or cases where multiple glaucoma surgeries have failed.

Other surgical directions

In recent years, there have also been studies on angle-closure glaucoma.Phacoemulsification lens removal surgery—While it is a common cataract surgery, local research shows that it can also effectively prevent increased intraocular pressure and improve angle-closure glaucoma, meaning that cataracts and glaucoma can be treated in a single surgery. Such options require individual consultation with an ophthalmologist.

8. Why should babies sleep on their backs?

The original text contained a section discussing how the habit of sleeping on one's stomach originates from infancy, and mentioned that "in the past, some medical opinions suggested that allowing infants to sleep on their stomachs helped reduce their fear." This section needs significant revision for two reasons:First, this "old viewpoint" lacks verifiable sources; second, current authoritative advice completely contradicts it.

The Department of Health's recommendations for family health services are very clear:

In other words, the core consideration for an infant's sleeping position isPrevention of Sudden Infant Death SyndromeIt's not intraocular pressure, but rather the pressure itself. Regarding the question of whether the habit of sleeping on one's stomach in infancy continues into adulthood and affects intraocular pressure,There is currently no confirmed connection.Therefore, it is not appropriate to describe the two as a cause-and-effect relationship. The original manuscript described infant sleeping position and adult intraocular pressure in the same paragraph, which could easily lead to misunderstanding. This article has changed it to describe them separately.

IX. Things you can do on a daily basis

Besides sleeping posture, there are some lifestyle details worth noting that are related to intraocular pressure or glaucoma management:

project	Practical advice
Drinking water method	Small amounts, multiple timesAvoid drinking large amounts of water in a short period of time; also avoid overeating. Drinking large amounts of water in a short period of time can cause a temporary increase in intraocular pressure.
clothes	Avoid wearingTight collar, tight bodyWear clothing, especially tight collars around the neck, to avoid affecting venous return from the head and neck.
Eye environment	AvoidProlonged use of eyes in dark environments(For example, use your phone in the dark); keep the lighting sufficient and soft; take a break every 30 minutes when using the screen and look at something in the distance.
Head posture	Avoid maintaining for a long timeHead lower than heartPostures (such as prolonged inversions or yoga inversions) can significantly increase intraocular pressure.
Mood and daily routine	Maintain a regular sleep schedule and stable emotions; avoid overwork and mental stress.
Smoking	Smoking is one of the risk factors associated with glaucoma, and quitting smoking is beneficial to overall health (including eye health).
Medication records	If used long-termsteroids(Regardless of dosage form), you should proactively inform your ophthalmologist and have your intraocular pressure checked regularly.
sports	Regular moderate-intensity exercise is generally beneficial; avoid actions that cause a rapid increase in intraocular pressure (such as holding your breath for a long time, carrying heavy loads, or inverting your head).

Regarding supplements, our consistent stance is: currently...There is no evidence that there are sufficient alternatives to glaucoma medication.Glaucoma patients should consult an ophthalmologist before considering any supplements to avoid interactions with prescription medications or delays in proper treatment. The nutritional foundation for daily eye care should still be a balanced diet; further reading can be found on this website.Elderly people are advised to have their eyes checked annually to prevent macular degeneration.〉。

10. Frequently Asked Questions (FAQ)

Does sleeping on your stomach really increase intraocular pressure?

Yes, but the magnitude needs to be considered in the context of actual figures. Studies on healthy adults show that intraocular pressure is approximately higher in the prone position than in the sitting position. 3 mmHg, about higher than when lying on your back 2 mmHgThe real problem is...timeIf the prone position is maintained for a long time (such as during surgery), the increase in intraocular pressure will accumulate. A meta-analysis showed that from the induction of anesthesia to the end of the prone position, the average cumulative increase in intraocular pressure was approximately [missing information]. 10 mmHgTherefore, sleeping on your stomach does indeed affect intraocular pressure, and "avoiding pressure on the eyeball" and "avoiding prolonged sleeping positions" are two practical adjustments that can be made.

Is the statement "Sleeping face down increases intraocular pressure by 140%" correct?

Inaccurate. This figure comes from a 2018 study that... 24 patients with disseminated pigmentary (PD) glaucoma or suspected glaucomaThis refers to individuals who are not typically healthy; the "−17% to +142%" mentioned in the report is...The range of the entire increase+142% is the case with the largest increase.Not the averageIn this study, the intraocular pressure increase was at least 331 TP4T for 641 TP4T and at least 501 TP4T for 431 TP4T. Therefore, the statement that "the intraocular pressure of ordinary people is 1401 TP4T higher when they sleep on their stomach" is an application of an extreme value of a specific group to everyone and is not valid.

Can sleeping with a higher pillow reduce eye pressure?

Current evidence leans towardson the contraryA 2026 study involving 144 glaucoma patients found that, compared to lying supine, elevating the head 20 to 35 degrees with two pillows significantly increased intraocular pressure, increased 24-hour intraocular pressure fluctuation, and decreased intraocular perfusion pressure; ultrasound examination also showed significant narrowing of the lumen of the internal and external jugular veins in this position. The authors believe the mechanism is...Jugular vein compression affects venous return.It's important to note that this is not the same as "tilting and raising the entire headboard" (keeping the body straight), as the two have different effects on the jugular vein. If you wish to adjust your sleeping position to manage intraocular pressure, it's advisable to discuss it with an ophthalmologist first.

Does high intraocular pressure equal glaucoma?

No. This is one of the most common misconceptions. Intraocular pressure higher than the reference range, but without glaucomatous damage to the optic nerve or visual field, is called...ocular hypertensionThis is a risk factor; some cases may develop glaucoma later in life, therefore regular monitoring is necessary. Conversely,Glaucoma can still occur even with intraocular pressure within the normal range (10 to 21 mmHg).This is known as normal-tension glaucoma. According to data from the National Chung Hsin University Ophthalmology Department, up to 501 TP4T in glaucoma patients falls within the "normal" or even low range of intraocular pressure. Diagnosis requires optic nerve examination and visual field testing.

If intraocular pressure is within the normal range, does that mean there is no risk of glaucoma?

No. There are three reasons:First, normal-tension glaucoma does exist.；Second, a single outpatient visit measurement may not reflect the situation throughout the day.Intraocular pressure varies with time and posture; clinically, 24-hour intraocular pressure fluctuations are taken into account.Third, intraocular pressure readings can be affected by factors such as corneal thickness.People with thinner corneas tend to have lower intraocular pressure readings, which may mask the actual level of elevation. Therefore, individuals with a family history of eye disease or who are considered high-risk should have regular eye exams as advised by their doctor, even if their intraocular pressure is normal.

Why should people with hypertension, hyperlipidemia, and hyperglycemia pay special attention to glaucoma?

Because metabolic-related diseases are associated with an increased risk of glaucoma. A meta-analysis including nine studies and over 2.25 million participants showed that metabolic syndrome was associated with an increased risk of glaucoma (OR 1.34). Further sub-analysis revealed...The association between hypertension and hyperglycemia was statistically significant, while the association between obesity and dyslipidemia was not statistically significant.In addition, diabetes can also lead to secondary glaucoma. However, it's important to note the opposite: glaucoma patients should avoid having excessively low blood pressure, as this reduces blood flow to the optic nerve and may worsen the condition. Therefore, blood pressure management should be assessed by a doctor.

Can glaucoma be cured and can vision be restored?

Glaucoma currentlyIt cannot be cured, and the damage caused cannot be reversed.The goal of treatment isLowering intraocular pressure can stop or slow further damage to the optic nerve and preserve existing vision.Lowering intraocular pressure is the only treatment to date with evidence showing it can stop or slow disease progression. Therefore, "early detection, early treatment" is not just a slogan—the earlier it's detected, the more vision can be preserved. Lost vision will not be restored through treatment, but consistent treatment can prevent further loss.

Which should be used first, laser treatment or eye drops?

Both can be first-line options for open-angle glaucoma and ocular hypertension. The LiGHT randomized controlled trial compared "selective trabeculoplasty (SLT) first" with "eye drops first," showing no significant difference in health-related quality of life between the two groups, while the laser group showed...Long-term disease controlThe advantages were: at 6 years, the eye with 69.81 TP4T maintained the target intraocular pressure without medication or surgery; the rate of disease progression was lower (19.61 TP4T vs 26.81 TP4T); the number of eyes requiring trabeculectomy was also lower (13 eyes vs 32 eyes); and no serious adverse events related to laser treatment occurred. The actual choice of treatment must be determined by an ophthalmologist based on the type and severity of glaucoma, follow-up appointments, and individual circumstances; it should not be decided by the individual.

When should one start getting a glaucoma screening in Hong Kong, and how often should it be done?

The general recommendation from the local ophthalmology community is:People over 40 years of age should have their first comprehensive eye exam.Those with a family history of glaucoma should start early (the risk is about six times higher if a first-degree relative has the disease). Afterwards, generally...Re-examination every 1 to 2 yearsIn addition to measuring intraocular pressure, the examination should include optic nerve examination, visual field testing, and, if necessary, OCT, gonioscopy, and corneal thickness measurement. If you have hypertension, diabetes, sleep apnea, or are using steroids long-term, you should inform your doctor.

Are the risks of infants sleeping on their stomachs the same as those of adults?

No, they are different; their focuses are completely different.The core risk of infants sleeping on their stomachs is Sudden Infant Death Syndrome (SIDS).Regarding breathing difficulties—the Department of Health's Family Health Service clearly states that the supine position (back against the bed) is the safest sleeping position for infants, while prone or side sleeping increases the risk of Sudden Infant Death Syndrome (SIDS). As for adults sleeping on their stomachs, the focus is on…Intraocular pressure and postural intraocular pressure elevation.at presentThere is no confirmed connection.Studies show that infantile stomach sleeping habits can persist and affect the risk of glaucoma in adulthood, so the two should not be confused.

Source of information

Official and institutional data

• Department of Health, Drug Office (Glaucoma Drugs)—Definition of glaucoma, open-angle and closed-angle glaucoma, risk factors, and the fact that "glaucoma is incurable and the damage is irreversible."
• Department of Health Family Health Service: Safe Sleep for Parents and Children: Preventing Sleep-Related Accidents and Sudden Infant Death Syndrome—Infant back sleeping recommendations, risks of prone and side sleeping
• Department of Health Elderly Health Service: Common Eye Problems and Eye Care Tips—Causes of glaucoma, warning signs requiring prompt medical attention, and eye care recommendations
• The Eye Centre, The Chinese University of Hong Kong: Myths about Glaucoma— Hong Kong has approximately 120,000 glaucoma patients, about one-seventh of whom are blind in both eyes; risk factors; sleep apnea and glaucoma; misconceptions about high intraocular pressure and glaucoma.
• A study by the Chinese University of Hong Kong (CUHK) is the first to discover the relationship between normal-tension glaucoma and silent stroke.—Up to 501 TP4T patients had normal or low intraocular pressure; glaucoma is the leading cause of blindness in Hong Kong.
• The Eye Centre, Chinese University of Hong Kong: Will New Minimally Invasive Surgery Be a Boon for Glaucoma Patients?--Classification and blood pressure reduction of minimally invasive glaucoma surgery (MIGS)
• The University of Hong Kong Glaucoma Information Network (Glaucoma)—General range of intraocular pressure, diagnostic methods, laser treatment and types of medications

Medical Research (PubMed)

• Intraocular Pressure Measurements in Standing, Sitting, Prone, and Supine Positions（J Pers Med (2024) — Intraocular pressure differences measured in four postures in 62 healthy subjects and 124 eyes.
• Effects of different sleeping positions on intraocular pressure in secondary open-angle glaucoma and glaucoma suspect patients（Clin Ophthalmol (2018) — 24 patients with pigment dissemination; intraocular pressure increase in supine position: −17% to +142% (upper limit of the interval, not the mean).
• Association of high-pillow sleeping posture with intraocular pressure in patients with glaucoma（Br J Ophthalmol (2026) — 144 glaucoma patients; elevated intraocular pressure and decreased intraocular perfusion pressure in the posture of sleeping with a high pillow, which is related to jugular vein compression.
• Relationship between sleep position and glaucoma progression（Curr Opin Ophthalmol (2019) – Postural elevation during lateral recumbency is approximately 2 mmHg or less; the association between sleeping position and glaucoma progression remains unestablished.
• Time Spent in Lateral Sleep Position and Asymmetry in Glaucoma（Invest Ophthalmol Vis Sci (2015) — Association between side-sleeping preference and asymmetric visual field defects
• Systematic Review and Meta-Analysis of Prone Position on Intraocular Pressure in Adults Undergoing Surgery（Int J Spine Surg (2020) — 9 studies, 229 adults; cumulative intraocular pressure increase of approximately 10 mmHg during prone position and possible relief measures.
• Effect of Prone Position on Intraocular Pressure in Patients Undergoing Nonocular Surgery: A Systematic Review（Cureus (2025) — 8 studies, 649 patients; intraocular pressure significantly increased when changing from a supine to a prone position.
• Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT)（Lancet (2019) — 3-year results of 718 patients
• LiGHT Trial: Six-Year Results of Primary Selective Laser Trabeculoplasty versus Eye Drops（Ophthalmology (2023) — Comparison of 6-year results with long-term disease control
• Global prevalence of glaucoma and projections of glaucoma burden through 2040（Ophthalmology (2014) — Prevalence rate of 3.541 TP4T in people aged 40 to 80, and 111.8 million people by 2040.
• Association between metabolic syndrome and the risk of glaucoma: a meta-analysis of observational studies（Diabetol Metab Syndr (2024) — 9 studies, over 2.25 million participants; OR 1.34; hypertension and hyperglycemia were significantly correlated, while obesity and dyslipidemia were not significantly correlated.
• Meta-Analysis of Association of Obstructive Sleep Apnea With Glaucoma（J Glaucoma (2016) — 6 studies, over 2.28 million participants; OR 2.46 (case-control) and 1.43 (generations)
• Association of diabetes, fasting glucose, and the risk of glaucoma: a systematic review and meta-analysis（Eur Rev Med Pharmacol Sci (2023) — The Association Between Diabetes Mellitus, Fasting Blood Glucose, and Intraocular Pressure

Source of the report

• This article was originally rewritten from an interview with local media.Ophthalmologist Qiu JunyuanThe report covers the causes of intraocular pressure, prone sleeping versus infant sleeping positions, the "vision thief" metaphor for glaucoma, and the classification of glaucoma surgeries. The original manuscript is a verbatim copy of existing articles on the site, and also includes a separate section... /en/ English version.
• The item "140%" in the text, after verification, corresponds to... Clin Ophthalmol A 2018 study on patients with disseminated pigmentation (PMID 30122886) reported an increase in TP4T ranging from -171 TP4T to +1421 TP4T.It represents the upper limit of the interval rather than the average, and the subjects are not generally healthy individuals.This discrepancy has been explained in the main text.
• The local epidemiological figures in Hong Kong are derived from Hospital Authority data (approximately 3 per 100 people aged 40 and above), publicly available data from the Eye Centre of the Chinese University of Hong Kong (approximately 120,000 patients, about one-seventh of whom are blind in both eyes), and public reports from local ophthalmological organizations. The statistical bases and years of these figures are different, and they should not be directly compared.