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• Baby, take off your tie
  Thomas Theelen
  Published on: 6 August 2003
• Neckties and IOP: to knot or not
  John R Paisey
  Published on: 6 August 2003

• Published on: 6 August 2003

  Baby, take off your tie

  • Thomas Theelen, opthalmologist

  Dear Editor

  I read with interest the article by Teng et al.[1] reporting the influence of tight neckties on intraocular pressure (IOP) measurement by Goldman applanation tonometry. They show that elevated IOP may be associated with a tightly worn necktie.

  For comprehensive ophthalmologists tight collars, maybe owing to tight neckties, are a virtual cause for erroneous high IOP measurements.[2] As sug...

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  Dear Editor

  I read with interest the article by Teng et al.[1] reporting the influence of tight neckties on intraocular pressure (IOP) measurement by Goldman applanation tonometry. They show that elevated IOP may be associated with a tightly worn necktie.

  For comprehensive ophthalmologists tight collars, maybe owing to tight neckties, are a virtual cause for erroneous high IOP measurements.[2] As suggested by Teng et al.[1] tight collars may affect venous blood flow and, consequently, raise episcleral venous pressure, thus causing elevated IOP. Another source for elevated IOP in patients with tight neckties may be a mechanism similar to valsalva manoeuvre as reported by Schuman et al.[3]

  There are two conclusions from the article by Teng et al.:
  First, ophthalmologists must be alert that tight neckties may affect IOP measurements. So, if the patient enters the office the slogan must be: "Baby, take off your tie."
  However, one has to bear in mind that the patient's position during Goldmann applanation tonometry is the not physiologic and, consequently, a tight necktie then might even be tighter. Conversely, the necktie will be looser when the patient is in a more physiologic pose.

  Therefore, it is uncertain if a tight necktie will be a risk factor for glaucoma. So, the preliminary motto for our patients' everyday life may be: "You can leave your tie on."

  References

  (1) Teng C, Gurses-Ozden R, Liebmann JM, Tello C, Ritch R. Effect of a tight necktie on intraocular pressure. Br J Ophthamol 2003;87:946-948.

  (2) The American Academy of Ophthalmology. Clinical measurement of intraocular pressure. In Basic and clinical science course; Section 10: Glaucoma. Liesegang TJ, Deutsch TA, Grand MG, (Eds). San Francisco: American Academy of Ophthalmology, 2002:20-23.

  (3) Schuman JS, Massicotte EC, Connolly S, et al. Increased intraocular pressure and visual field defects in high resistance wind instrument players. Ophthalmology 2000;107:127-133.

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  Conflict of Interest:
  None declared.

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• Published on: 6 August 2003

  Neckties and IOP: to knot or not

  • John R Paisey, Research Fellow
  • Other Contributors:
    • Mayank Patel, Steve Lash

  Dear Editor

  We read with interest the research article on the effect of a necktie on intra ocular pressure.[1]

  The article was striking in it's failure to discuss the contribution of sartorial factors in the this matter. It should be obvious to even casual attenention that a full-Windsor differs markedly from a four-in-the-hand knot in its propensity to impinge jugular drainage and that is without even conside...

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  Dear Editor

  We read with interest the research article on the effect of a necktie on intra ocular pressure.[1]

  The article was striking in it's failure to discuss the contribution of sartorial factors in the this matter. It should be obvious to even casual attenention that a full-Windsor differs markedly from a four-in-the-hand knot in its propensity to impinge jugular drainage and that is without even considering the effect of the Pratt which is so obviously relevant in this regard. It is not only knots that should be discussed but also the garment itself, surely the authors are not suggesting that a kipper is equivalent to a pencil tie and the opportunity to scrutinise the excess of the puce, proptotic visage so prominent amongst our own ranks is surely not unrelated to our own passion for the dickey bow.

  Reference

  (1) Teng C, Goses-Ozden R, Liebmann JM et al. Effect of a tight necktie on intraocular pressure. Br J Ophthalmol 2003;87: 946-948.

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  Conflict of Interest:
  None declared.

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