Progression of glaucoma associated with the Sirsasana (headstand) yoga posture

Abstract

This article reports a case of progressive glaucomatous optic neuropathy and visual field loss that occurred in a patient who practiced the Sirsasana (headstand) yoga posture on a daily basis for many years. Visual field analysis was performed through standard automated perimetry. Intraocular pressure (IOP) was measured through pneumotonometry in the sitting position and in the head-down position. Stereo-optic disc photographs were obtained. IOP increased significantly in the head-down position. Optic disc evaluation revealed a new disc hemorrhage in the left eye. Visual field analysis over a period of 2 y showed progression of a superior arcuate defect in the left eye. Transient increases in IOP associated with the yoga headstand posture may lead to progressive glaucomatous optic nerve damage and visual field loss.

Adverse Events Associated with Yoga: A Systematic Review of Published Case Reports and Case Series

“…Of the included 37 reports, 19 originated from the USA [28], [31]–[33], [35], [38]–[40], [43]–[47], [49], [52], [55]–[57], [61], 1 from Canada [60], 2 from the UK [51], [59], 1 from Germany [42], 1 from Switzerland [25], 2 from Italy [26], [34], 1 from Denmark [36], 5 from India [29], [41], [48], [53], [54], and 1 each from Nepal [27], China [37], Taiwan [58], South Korea [30], and Australia [50]. The first included report was published in 1969, the number of reports published each year gradually increased until 2012 (Figure 2).…”

“…3 cases of glaucoma [25], [35], [38], 3 cases of osteopenia [61], and 1 case each of asthma [55], psychosis [45], and affective disorder [59]. One case had a congenital hyperelasticity of connective tissue which might have facilitated the occurence of adverse events [34].…”

“…Regarding specific yoga postures, the headstand (Sirsasana) was practiced in 10 cases [25], [27], [28], [32], [35], [37], [38], [46], [52], [53], the shoulder stand in 3 cases [36], [39], [52], variations of the lotus position (Padmasana) in 3 cases [26], [47], [56], forceful breathing techniques in 3 cases [40], [41], [55], voluntary vomiting (Kunjal Kriya) in 2 cases [27], [48], and postures that included putting 1 or 2 feet behind the head in 2 cases [34], [50]. Kneeling posture (Vajrasana) [31], locust pose (Salabhasana) [36], bridge pose (Setu bandha) [49], seated forward bend (Paschimottasana) [57], and downward-facing dog (Adho mukha savasana) [58] were practiced in 1 case each.…”

“…Nine cases reported orbital adverse events including acute glaucoma [36], [52], worsening of chronic glaucoma [25], [35], [38], and orbital varices or vein occlusion [32], [46], [49], [53]. Peripheral neuropathy was reported by 4 cases [34], [47], [56], [57], stroke by 3 cases [37], [39], [49], and transient headache by 7 cases [60].…”

“…[1], [72]. Two of the 3 cases who had practiced shoulder stand [36], [52] and 8 of the 10 cases that had practiced head stand [25], [32], [35], [37], [38], [46], [52], [53] reported orbital adverse events, mainly glaucomatous symptoms. It has been reported that headstand induces a twofold increase in intraocular pressure [73].…”