Study: Psychological Stress Elevates IOP, Even in Healthy Individuals

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Research links an increase in social stressors, such as anxiety and depression, with elevations in intraocular pressure.

Psychological stress can significantly elevate intraocular pressure (IOP), even in healthy individuals, according to a report published in Ophthalmology Glaucoma. Researchers say the relationship between IOP and psychophysiologic stress supports a need for ophthalmologists to promote anti-stress strategies, according to the research. 

Patients were evaluated using the Trier Social Stress Test (TSST) to determine the impact of stress on IOP. All participants (17 in the study group and 11 in the control group) were older than 18 years, had peak IOPs lower than 21 mm Hg, and showed no signs of glaucomatous neuropathy. Patients with an existing anxiety or depressive disorder diagnosis were excluded.  

The stress test required participants to speak in front of an unresponsive audience and complete a surprise mental arithmetic test. These conditions can elevate cortisol levels 2 to 3 times what a person experiences in low stress situations or environments, according to investigators.

“All participants underwent a modified diurnal tension curve (DTC) 1 week before the TSST, with 3 IOP measurements performed between 8:00 AM and 2:00 PM. We evaluated the response to the TSST measuring the levels of salivary cortisol, IOP, and heart rate before, immediately after, and 40 minutes after TSST. The State Trait Anxiety Inventory (STAI) was applied to evaluate the levels of anxiety at the same time intervals.”

They found that, at baseline, there were no significant differences between case and controls regarding age (52.2±6.26 vs 53.8±8.4 years, P =.661), sex (52.94% male vs 45.45% female, P =.669), and ethnicity. Salivary cortisol (6.8 nmol/l, P <.001) and heart rate (7.2 beats/min, P =.035) increased significantly after the TSST. 

They observed a mean IOP increase of 1.0 mm Hg (right eye, P =.003) and 1.1 mm Hg (left eye, P =.004) when comparing IOP measurements obtained during the DTC and immediately after TSST. In addition, 35% (6 out of 17) of the participants in the study group showed an IOP increase higher than 2 mm Hg after the test compared with 18% (2 out of 11) in the control group. 

The STAI state score significantly increased after the stress event compared with baseline (P =.026) and decreased from post stress to the recovery period (P =.006) in the study group. The control group did not show significant changes in IOP, heart rate, salivary cortisol levels, and STAI scores.

The findings demonstrate the importance of stress management as a preventative strategy for glaucoma development, according to the report. If stress is induced by anxiety and depression disorders, the resulting increase in IOP can put individuals at risk, the research suggests. 


Abe R, Silva T, Dantas I, et al Can psychologic stress elevate intraocular pressure in healthy individuals?Ophthalmol Glaucoma. 2020;3(6):426-433. doi:10.1016/j.ogla.2020.06.011.