Here are some studies showing changes in intraocular pressure (IOP) in response to stress.
Main Study: Psychological Stress and Intraocular Pressure in Glaucoma (2024)
Title & Authors: “Psychological Stress and Intraocular Pressure in Glaucoma: A Randomized Controlled Trial.” – Nathalie S. Ferreira, Vital P. Costa, Juliana F. Miranda et al. (Published 2024 in Ophthalmology Glaucoma) (Psychological Stress and Intraocular Pressure in Glaucoma - Ophthalmology Glaucoma). The study was also discussed in Stress Found to Increase IOP About 4mm Hg in Glaucoma Patients.
Methodology: Randomized controlled trial on 39 patients with primary open-angle glaucoma (POAG). Participants were split into a stress group (18 patients) who underwent the Trier Social Stress Test (TSST) – a standardized acute stress protocol involving a mock job interview and mental arithmetic – and a control group (21 patients) with no stress intervention (Stress Found to Increase IOP About 4mm Hg in Glaucoma Patients). Baseline intraocular pressure was recorded via a modified diurnal tension curve (multiple IOP measurements between 8 AM–2 PM prior to the test) for all patients (Stress Found to Increase IOP About 4mm Hg in Glaucoma Patients). IOP was then measured (Goldmann applanation) immediately after the TSST, and stress biomarkers (salivary cortisol, salivary amylase), blood pressure, heart rate, and anxiety scores (STAI questionnaire) were tracked at baseline and post-stress.
Key Findings: Acute psychological stress caused a significant rise in IOP in glaucoma patients. On average, IOP increased by about +3.8 mmHg in the right eye and +4.1 mmHg in the left eye immediately after the stress test (compared to baseline) (Psychological Stress and Intraocular Pressure in Glaucoma - Ophthalmology Glaucoma). In fact, 61% of the stressed glaucoma patients experienced an IOP spike >4 mmHg following the TSST, whereas no control patients showed such a jump (Psychological Stress and Intraocular Pressure in Glaucoma - Ophthalmology Glaucoma). Stress indicators confirmed the efficacy of the stress test: for example, salivary cortisol rose by ~5.9 nmol/L and mean arterial pressure by ~10 mmHg in the stress group (Psychological Stress and Intraocular Pressure in Glaucoma - Ophthalmology Glaucoma). The study concluded that psychological stress can transiently but significantly elevate IOP in POAG, with an ~4 mmHg spike that is not only statistically significant but clinically relevant (Stress Found to Increase IOP About 4mm Hg in Glaucoma Patients) (since even short-term IOP elevations may contribute to glaucoma progression). The authors suggest that repeated stress could potentially compromise long-term IOP control in glaucoma patients (Stress Found to Increase IOP About 4mm Hg in Glaucoma Patients).
Additional Studies On Stress and Elevated IOP
Abe et al., 2020 (Ophthalmology Glaucoma): A case-control study asked whether healthy eyes also show IOP changes under stress. Using a TSST protocol in 28 healthy adults (17 stressed vs 11 controls), they found a smaller but significant post-stress IOP rise: about +1.0 mmHg (right eye) and +1.1 mmHg (left eye) on average in the stress group compared to baseline (Can Psychologic Stress Elevate Intraocular Pressure in Healthy Individuals? - PubMed). About 35% of the stressed subjects had >2 mmHg IOP increases (versus 18% in controls) (Can Psychologic Stress Elevate Intraocular Pressure in Healthy Individuals? - PubMed). No IOP change occurred in controls, and stress hormone levels (cortisol) and anxiety scores rose only in the stress group (Can Psychologic Stress Elevate Intraocular Pressure in Healthy Individuals? - PubMed) (Can Psychologic Stress Elevate Intraocular Pressure in Healthy Individuals? - PubMed). This showed that even in individuals without glaucoma, acute psychological stress can measurably raise IOP (though typically much less than it raises IOP for those living with glaucoma).
Jiménez & Vera, 2018 (Applied Ergonomics): This study examined academic examination stress as a natural stressor. In a trial with 33 university students, IOP was measured before and after a real exam and compared to a non-stress control condition. Results showed higher IOP under exam stress than in the control session (Effect of examination stress on intraocular pressure in university students - PubMed), alongside elevated blood pressure and heart rate, indicating that the mental stress of an exam can cause a significant IOP increase. The authors suggested IOP could serve as an objective physiological marker of acute mental stress in everyday scenarios (Effect of examination stress on intraocular pressure in university students - PubMed) (Effect of examination stress on intraocular pressure in university students - PubMed).
Vera et al., 2020 (Applied Ergonomics): In a follow-up experiment, 32 students defending their thesis (a public speaking exam) were studied to see how anxiety levels modulate IOP response. Those undergoing the stressful oral presentation had significant IOP elevations before and immediately after the speech, and the magnitude of IOP increase correlated strongly (r ≈ 0.71) with each individual’s reported public-speaking anxiety (The intraocular pressure responses to oral academic examination: The influence of perceived levels of public speaking anxiety - PubMed). In short, the more anxious the person felt, the larger their stress-induced IOP spike – highlighting a dose-response relationship between psychological stress intensity and IOP elevation (The intraocular pressure responses to oral academic examination: The influence of perceived levels of public speaking anxiety - PubMed). This reinforced the idea that stress-induced IOP spikes are real and proportional to stress perception, further validating IOP as an indicator of stress.
Gillmann et al., 2019 (BMC Ophthalmology): A notable case report described a 78-year-old glaucoma patient who experienced a dramatic IOP spike precipitated by acute emotional stress (a severe family crisis) (Acute emotional stress as a trigger for intraocular pressure elevation in Glaucoma | BMC Ophthalmology | Full Text). Her eye pressures, previously well-controlled after glaucoma surgeries, spiked asymmetrically immediately following the stressful event, reaching levels of “severe ocular hypertension” (exact values not stated) and then subsiding back to normal about 24 hours later as her stress abated (Acute emotional stress as a trigger for intraocular pressure elevation in Glaucoma | BMC Ophthalmology | Full Text). No other cause for this transient IOP surge was found. The authors concluded that intense emotional stress alone can trigger acute IOP elevation in susceptible glaucoma patients (Acute emotional stress as a trigger for intraocular pressure elevation in Glaucoma | BMC Ophthalmology | Full Text). While a single-patient report, it dramatically illustrates how stress can “severely affect IOP in patients suffering from glaucoma” (Acute emotional stress as a trigger for intraocular pressure elevation in Glaucoma | BMC Ophthalmology | Full Text), aligning with the controlled studies above.
Conclusion:
Multiple lines of research – from controlled trials to real-life stress scenarios – demonstrate that psychological stress can cause a measurable rise in intraocular pressure. In glaucoma patients, an acute stressor (like the TSST) has been shown to spike IOP on the order of ~4 mmHg (Psychological Stress and Intraocular Pressure in Glaucoma - Ophthalmology Glaucoma), a significant jump that over 60% of stressed patients experienced. Healthy individuals also exhibit IOP increases under stress, though typically more modest (Can Psychologic Stress Elevate Intraocular Pressure in Healthy Individuals? - PubMed).
Sources: The primary study above was published in Ophthalmology Glaucoma in 2024 (See https://www.ophthalmologyglaucoma.org/article/S2589-4196(24)00131-5/fulltext and Stress Found to Increase IOP About 4mm Hg in Glaucoma Patients), with supporting evidence from studies in Ophthalmology Glaucoma (2020) (Can Psychologic Stress Elevate Intraocular Pressure in Healthy Individuals? - PubMed), Applied Ergonomics (2018 (Effect of examination stress on intraocular pressure in university students - PubMed), 2020 (The intraocular pressure responses to oral academic examination: The influence of perceived levels of public speaking anxiety - PubMed)), and BMC Ophthalmology (2019) (Acute emotional stress as a trigger for intraocular pressure elevation in Glaucoma | BMC Ophthalmology | Full Text). Each confirms that psychological stress can cause a notable uptick in intraocular pressure.