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To investigate the effect that extended wear of a tight necktie has on the intraocular pressure (IOP), measured by Goldmann applanation tonometry in a normal and aged-matched glaucoma group.One eye of 18 normal and 19 primary open-angle glaucoma patients was included in this prospective study. The intraocular pressure of each patient's randomly selected eye was measured with the patient dressed in an open shirt collar, again 3 minutes after their collar was fastened and necktie tightened, again after a further 12 minutes, and finally 3 minutes after the necktie was loosened and collar unfastened. The same examiner performed all measurements in a masked fashion.The mean intraocular pressure in the normal group (n = 18) increased by 0.56 mm Hg (P = 0.30) and increased significantly (*) in the glaucoma group (n = 19) by 1.58 mm Hg (P = 0.001*) after tightening the necktie for 3 minutes. The mean IOP then decreased after leaving the necktie on for a further 12 minutes, by 0.89 mm Hg (P = 0.08) in the normal group and decreased significantly by 0.94 mm Hg (P = 0.04*) in the glaucoma group. Finally after loosening the necktie for 3 minutes (immediately after 15 minutes of continuous necktie wear) the mean IOP decreased in the normal group by 0.89 mm Hg (P = 0.02*) but only minimally in the glaucoma group by 0.16 mm Hg (P = 0.72). The patient's age or collar size showed no significant correlation with the change in mean IOP following tight necktie wear.A significant increase in IOP after 3 minutes of tight necktie wear occurred only in the glaucoma group, but this increase was followed by a significant decrease in IOP after 15 minutes of tight necktie wear. Avoidance of wearing a tight necktie over an extended period is therefore not necessary in patients with glaucoma.