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Over the last few years there has been a considerable internet “buzz” regarding medical research which seems to prove a link between an over-tight necktie and an increase in IOP (internal Optic Pressure) in the eyeball; possibly leading to glaucoma and damage to sight. This article aims to assess the risk and proffer advice to those concerned.

Firstly the preservation of a person’s sight should not be a topic for amateur speculation or self-diagnosis. It is far too complex an area of the body for the unskilled to dabble in; and so a regular visit to an optometrist should feature in yearly health checks. This is particularly the case if over 50 years old, as there is a natural correlation between the gradual increase in eye-related problems and advancing years. Any early signs of eye trouble are easily picked up by modern day “field of vision” and other sight tests.

But now having got the almost obligatory “health warning” against self-doctoring out of the way, an introduction to some of the latest findings related to increased pressure in the eye and its possible effects on sight would not be out of place.

Research Studies.

The piece of research often quoted in this context is a small study first reported in the British Journal of Ophthalmology (Br J Ophthalmol 2003;87:946–948). This study by Dr R. Ritch et al. at the New York Medical College, Valhalla NY, USA, followed a group of 40 patients and assessed their intraocular eye pressure with and without a tightened necktie.

Results found an increase in pressure on average of between 1 and 2.6 mm Hg (millimetres of Mercury) after a necktie had been tightened around the subject’s neck; while the increase for some subjects was as high as 4 mm Hg. In percentage terms this ranged from a 10 – 20% increase in pressure. This increase in pressure is likely to be caused by a similar mechanism to that induced in the head and upper body by what is known as a valsalva manoeuvre; that is a constriction in blood vessels by straining, bending over, or simply coughing. This constriction in veins, particularly the Jugular Vein, by wearing a tight tie can result in slowing the drainage flow from the eye, and thus inflating the IOP temporarily.

Another study by Dr Susan Watkins at Cornell University reported that out of a sample of 94 white-collar males two thirds wore shirt collars smaller than the resting circumference of their necks, and so when worn with a tie, caused discomfort and some visual problems. Subjects with constricted necks were found to have poorer visual discrimination than those with unconstricted necks when asked to assess the point at which a flickering light appeared constant.

Both these studies witnessed a correlation of tight neckties with either a reduction in visual acuity or an increase in intraocular pressure. What, if anything, we should do about this correlation is another matter. These results, even if confirmed by other larger scale studies, should not be extrapolated to the point of believing that this increase in pressure automatically predisposes an increasing likelihood of developing Glaucoma. In deed these results may well simply provide a useful warning to ophthalmologists of the possible false positive IOP measurements of patients tested while wearing neckties. An understanding of both the eye and the specific pressure-related disease is necessary to evaluate the likely effect of transient changes in this area.

What is Glaucoma?

Glaucoma as a medical term refers to the actual damage done to the optic disc and nerve by a variety of factors, only one of which is the pressure inside the eye. Although an increase in IOP is a major warning indicator, it does not automatically result in damage to the nerve or the patient’s sight. There are cases where a patient develops nerve damage when the internal eye pressure is quite low, alongside cases where a patient presents with a high IOD over a long period without developing any noticeable nerve damage, field of vision loss, or any disturbance to their sight.

Blink and You’ll Miss It.

Another point to consider when assessing the likely damage due to a temporary increase in pressure is the context in which this increase exists. The simple fact is that pressure in the eye alters significantly with a variety of transient stimuli; namely blinking, looking up, down, left and right, as well as the normal fluctuations in drainage rates due to the body’s natural circadian or daily rhythms. Each one of these influences raises or lowers the IOP every day, hour by hour, and even second by second. As a sneeze can momentarily increase the pressure inside the eye to almost 100 mm Hg we must assume that the eye is built to take this constant but transient fluctuation without coming to any harm. In fact it has been postulated that this constant “exercising” of the structure of the eye may be necessary to keep the drainage apparatus healthy and functional. So it may be reasonable to assume that the addition of one more extra, tie-related squeeze may not have much long term effect. This is not to say that an over-tightened necktie should be dismissed as totally incidental to the future of a person’s sight; only that it should not be top-of-mind when considering the future health of a man’s eyes. A little dose of common sense should be the first treatment taken down from the bathroom cabinet when contemplating whether or not to wear a tie.

Better Safe than Sorry?

However, it is perhaps important to bear in mind that of all the areas of the human body, the neck is particularly placed to require special care; a unique conduit through which much of the body’s fluid and nerve signals flow at some time or other. With important sensory apparatus of eyes, ears, nose, mouth and brain located at one end of this crucial “pass” and the more mechanical plumbing, pumping and muscular work areas of the body at the other, then it’s not surprising if we worry a little more than usual about any potential squeezing of the path through this vital “pass”.

As with any medical condition that may have a possible (if remote) “cause and effect” relationship, the answer often lies in the hands of the patient. If regular tie wearers wish to be completely safe in the knowledge that they are not doing their eyes any real harm, then the first thing they must do is make sure they wear a collar that fits their neck. (Not an altogether obvious practice for two thirds of the male tie-wearing population according to Dr Susan Watkins at Cornell.)

16.5 Inch Shirt – But 17 Inch Neck? What Do You Do?

If a whole new wardrobe of slightly larger shirts is out of the question, then perhaps a less costly investment in a shirt collar extender would do the job. It is however important to choose wisely in this area. There are several types of shirt collar extender. Some merely use elastic or springs to join the two ends of the collar band and thus maintain a squeezing pressure on the neck even after the collar’s extension. Others simply connect the top button with a floppy piece of material that does not support the collar extension. Both these types of shirt collar extender will not provide the stiffened extension to a collar band necessary to keep a tightened tie away from the neck. Only one collar extender, or expander, presently on the market seems to provide the required rigidity to extend a man’s shirt collar and stop his tie overly squeezing his neck. They have been designed to allow a tightening of a necktie against the extended collar, and not against a sensitive neck, thus reducing the pressure on the throat and by association the blood vessels and subsequently the eyes. Those shirt collar extenders are UNSTRANGLER COLLAR EXTENDERS, and at the moment they are only available online.

Medical Conclusions.

  1. Constriction of the neck can elevate eye pressure.
  2. But there is no definitive proof of this temporary increase in pressure damaging the optic nerve.
  3. This elevation in pressure is most likely to raise false positive results when an ophthalmic surgeon tests the pressure in your eyes when you are wearing a tie.
  4. Even so, to be on the safe side it may still be worth trying to avoid wearing a tight tie for too long a period
  5. And when wearing a tie, make sure your shirt collar is the right size and fits your neck comfortably.
  6. If some of your shirts are a little tight due to shrinkage – use a collar extender.
  7. And finally; most importantly; get your eyes tested by an Optometrist regularly (once a year if over 50)