Intraocular pressure (IOP) fluctuates significantly in response to body position. The IOP is lowest in the sitting posture and increases in the order of supine and lateral decubitus positions.
These changes are attributed to the increase in episcleral venous pressure and choroidal vascular volume. The uveal tissues also develop congestion and expansion from increased venous and arterial pressures in the orbit, contributing to the increased IOP.
Therefore, postural modification may serve as a potential adjunctive strategy for IOP management in glaucoma patients.
In a study by Liu et al, involving 144 glaucoma patients, IOP was measured and compared between the high-pillow position (head elevated by 20–35° using two pillows) and the supine position. Additionally, changes in jugular venous lumen in response to postural variation were evaluated via ultrasonography in 20 healthy volunteers.
The authors reported that, compared with the supine position, the high-pillow position was associated with significantly elevated IOP, increased 24-hour IOP fluctuation and reduced ocular perfusion pressure (OPP) (all p<0.001).
Greater postural IOP fluctuation (ΔIOP) was observed in younger individuals (p=0.027) and patients with primary open-angle glaucoma (POAG) (p<0.001).
Multiple regression analysis identified thicker central corneal thickness and the presence of POAG (vs normal-tension glaucoma) as positive predictors of larger ΔIOP changes (both p<0.05).
Ultrasonography in healthy volunteers revealed significant constriction of both internal and external jugular venous lumen in the high-pillow position (all p<0.001), accompanied by an increase in maximum blood flow velocity of the internal jugular vein (p=0.013).
Therefore, compared with the supine position, the high-pillow position is associated with increased IOP and decreased OPP in patients with glaucoma, which may be linked to jugular venous compression.
ADVICE:
Patients with glaucoma may benefit from avoiding sleeping postures that induce jugular venous compression to mitigate postural IOP elevation.
REFERENCE:
Liu T, Hu M, Liu X, et al. Association of high-pillow sleeping posture with intraocular pressure in patients with glaucoma. British Journal of Ophthalmology. Published Online First: 27 January 2026. doi: 10.1136/bjo-2025-328037.
