Pressure Behind Right Eye When Holding Head Down
The pressure you feel behind your right eye when holding your head down is most likely caused by a normal physiological increase in intraocular pressure that occurs with head-down positioning, which can increase from baseline values of 15-17 mmHg to 31-38 mmHg within minutes of inversion. 1, 2
Understanding the Mechanism
When you bend forward or hold your head down, gravity causes immediate changes in ocular hemodynamics:
- Intraocular pressure (IOP) doubles within minutes of assuming a head-down position, rising from approximately 16 mmHg to 32-34 mmHg in healthy eyes 1, 2
- This pressure increase occurs because venous drainage from the eye is impaired while arterial inflow continues, causing blood to pool in the choroidal vessels 3
- The sensation of pressure or fullness is a direct result of this elevated IOP stretching the globe 1
When This Is Normal vs. Concerning
This is typically benign if:
- The pressure sensation resolves immediately when you return to upright position 2
- You have no visual changes, eye pain, or redness 1
- The sensation is bilateral or alternates between eyes 2
Seek ophthalmologic evaluation if:
- You have pre-existing glaucoma or ocular hypertension, as these eyes may reach pressures of 37+ mmHg with head-down positioning and are more vulnerable to damage 1
- The pressure persists after returning upright 2
- You experience visual changes, severe pain, or see halos around lights 4
- The sensation is consistently unilateral (right eye only), which could suggest asymmetric vascular response or underlying pathology 5
Practical Recommendations
- Avoid prolonged head-down activities if you have glaucoma, as the sustained IOP elevation (which can last throughout the inverted position) may damage the optic nerve 1
- Limit inversion exercises or yoga poses that place your head below your heart for extended periods 1, 2
- If you must work in head-down positions, take frequent breaks to allow IOP to normalize 3
Important Caveats
The head-down position increases IOP through purely mechanical/gravitational effects, not from direct compression 1, 2. However, if you're experiencing this during sleep or with face-down positioning, ensure you're not inadvertently compressing the eye against a pillow, which could cause more serious complications like central retinal artery occlusion 4. The Trendelenburg (head-down) position combined with prone positioning creates the highest risk for ocular complications 4.
If symptoms persist or worsen, a comprehensive eye examination including IOP measurement and optic nerve assessment is warranted to rule out underlying glaucoma or other pathology 4.