Intraocular pressure (IOP) can be lowered through eye drops, laser procedures, surgery, and several lifestyle adjustments. Normal IOP falls between 10 and 21 mmHg, and readings consistently above 21 mmHg are classified as ocular hypertension, a major risk factor for glaucoma. The right approach depends on how elevated your pressure is and whether any optic nerve damage has already occurred.
Prescription Eye Drops
Medicated eye drops are the most common first-line treatment. They work in two basic ways: reducing the amount of fluid your eye produces or helping that fluid drain out more efficiently. The main classes include prostaglandin analogs, beta-blockers, carbonic anhydrase inhibitors, and alpha agonists.
Prostaglandin analogs (the drops you typically use once at bedtime) lower pressure by opening an alternative drainage route in the eye. Beta-blocker drops reduce the amount of fluid the eye makes in the first place. Many people start on one class and add a second if the pressure doesn’t reach their target. Combination drops that package two classes into a single bottle are also available, which simplifies the routine and can reduce side effects compared to using two separate bottles.
Laser Trabeculoplasty
Selective laser trabeculoplasty (SLT) is a quick, in-office procedure that uses targeted laser pulses to improve drainage through the eye’s natural outflow channel. A session takes about five minutes per eye. In clinical trials, SLT reduced IOP by roughly 6 to 7 mmHg, and that reduction held at the three- and five-year marks. Some patients use it as a first treatment instead of daily drops.
An older version called argon laser trabeculoplasty (ALT) produces similar pressure reductions, but SLT has one practical advantage: it can be repeated if the effect fades over time, because it causes less permanent tissue change. The pressure-lowering effect of SLT does diminish in some patients after one to two years, so periodic monitoring is important.
Minimally Invasive Glaucoma Surgery
When drops and laser aren’t enough, minimally invasive glaucoma surgery (MIGS) offers a middle ground before more aggressive operations. These procedures involve tiny implants placed inside the eye’s drainage system to keep fluid flowing. Two of the most studied devices are the iStent inject and the Hydrus Microstent.
The Hydrus is an 8 mm scaffold made of a nickel-titanium alloy that props open part of the eye’s natural drainage canal. In a five-year study, it achieved about a 30% reduction in IOP (roughly 8 mmHg) when combined with cataract surgery. In shorter-term real-world data, the Hydrus group saw a 20% IOP reduction at 12 months. The iStent inject, a much smaller device inserted into the drainage meshwork, showed IOP reductions ranging from 11% to 30% across prospective studies and cut the number of daily eye drop medications by about 70%. A study of double iStent implantation without cataract surgery reported a 42% average IOP reduction.
MIGS procedures are typically performed during cataract surgery, though standalone implantation is possible. Recovery is faster and complication rates are lower than traditional glaucoma surgery, making them a good option for mild to moderate disease.
Aerobic Exercise
Regular aerobic activity provides a real, measurable drop in eye pressure. A single session of vigorous aerobic exercise can lower IOP by about 4 to 6 mmHg, though this effect is temporary, returning to baseline within roughly 40 minutes. The benefit comes from consistent, repeated exercise rather than a single workout.
Interestingly, long-term fitness conditioning changes the dynamic. One study found that after four months of exercise training, the acute IOP drop after a hard workout shrank from about 5.9 mmHg to just 1.6 mmHg. This doesn’t mean exercise stops helping. It likely reflects a lower resting IOP baseline in conditioned individuals, so there’s less room for an acute dip. Walking, cycling, swimming, and jogging are all reasonable choices.
Positions and Activities That Raise IOP
Certain body positions spike eye pressure dramatically. Yoga headstands (Sirsasana) double IOP almost instantly. In a study of yoga practitioners, the average increase was about 15 mmHg, jumping from a normal baseline to roughly 30 mmHg, and this elevation persisted for as long as the headstand was held. Shoulder stands and other inverted poses carry similar risks.
Heavy weightlifting can also cause sharp, temporary IOP increases, particularly when you hold your breath and bear down (the Valsalva maneuver). If you have elevated IOP or glaucoma, switching to lighter weights with more repetitions and breathing steadily through each lift is a simple way to reduce spikes.
Sleep Position and Head Elevation
IOP naturally rises when you lie flat, which is one reason eye pressure tends to be highest in the early morning hours. Elevating the head of your bed by about 20 to 30 degrees can meaningfully lower nighttime IOP. In one study, a 30-degree head-up position reduced IOP by an average of 2.8 mmHg compared to lying flat, a roughly 16% drop. Nearly all participants (96%) saw some reduction.
The method matters. Raising the entire head of the bed (using risers or a wedge under the mattress) works better than stacking pillows, which tend to flex the neck without truly elevating the head relative to the heart. A foam wedge pillow is a reasonable middle ground. Research across both glaucoma patients and healthy subjects has consistently shown reductions of 1.5 to 3.2 mmHg with a head-up sleeping position.
Fluid Intake and Caffeine
Drinking a large volume of water quickly can spike IOP more than most people realize. In a clinical comparison, consuming a large bolus of water produced a 4.3 mmHg average rise in eye pressure (about a 28% increase from baseline), peaking within 15 to 30 minutes. By contrast, a caffeine dose caused a smaller but still notable rise of about 1.8 mmHg (12%).
The practical takeaway: spread your fluid intake throughout the day rather than gulping large amounts at once. There’s no need to restrict total water intake, just avoid drinking more than about 500 mL (roughly two cups) within a short window. Coffee and tea in moderate amounts are fine for most people, though those with borderline or poorly controlled IOP may want to limit themselves to one or two cups at a time.
Supplements
One supplement combination with clinical data behind it is Mirtogenol, a blend of bilberry extract and pine bark extract. In a six-month trial of people with ocular hypertension, Mirtogenol lowered IOP from an average of 25.2 mmHg to 22.0 mmHg, a drop of about 3 mmHg. Nineteen out of 20 treated patients saw some reduction, compared to just 1 out of 18 in the untreated control group. The effect plateaued at three months with no additional improvement at six months.
Leafy green vegetables rich in dietary nitrates (spinach, kale, arugula) are often recommended for eye health, and higher nitrate intake has been linked to lower rates of open-angle glaucoma. However, a large population study (the Rotterdam Study) found that dietary nitrate intake did not directly lower IOP itself. The protective effect may work through improved blood flow to the optic nerve rather than pressure reduction. This means greens are worth eating for overall eye health, but they shouldn’t be counted on as a pressure-lowering strategy specifically.