The Effects of Bariatric Surgery on Intraocular Pressure and Glaucoma Risk: A Systematic Review

Abstract

Background: One of the ocular conditions associated with obesity is elevated intraocular pressure (IOP), a major modifiable risk factor for glaucoma. In addition to being a successful long-term weight management strategy, bariatric surgery may have additional advantages for the eyes. Objective: To methodically assess how bariatric surgery affects obese patients' intraocular pressure and risk of glaucoma. Methods: A comprehensive literature search was conducted using PubMed, Scopus, Web of Science, and Google Scholar to locate papers published between July 2011 and July 2025. The included studies assessed how bariatric procedures affected glaucoma or intraocular pressure. Data retrieved included surgical type, sample size, follow-up duration, glaucoma markers, alterations in intraocular pressure, and complications. Results: Fifty-five studies satisfied the inclusion criteria. 48 of these patients had postoperative IOP reductions ranging from 1.4 to 3.5 mmHg at various follow-up intervals. A lower incidence of glaucoma was noted in a number of large cohort studies, especially following duodenal switch and gastric bypass surgery. Numerous explanations were put forth, such as improved ocular perfusion, decreased episcleral venous pressure, and modified metabolic and inflammatory processes. Nonetheless, the structural alterations in the optic nerve perfusion and retinal nerve fiber layer (RNFL) differed from study to study. Potential surgical complications that could impair visual function were found to be nutritional deficiencies, particularly vitamin A deficiency. Conclusion: Bariatric surgery is linked to lower intraocular pressure and may help lower the risk of glaucoma, especially in obese high-risk patients. It is advised that bariatric care pathways include routine ophthalmologic evaluation. To fully understand the long-term ocular effects and structural alterations that occur after different bariatric procedures, more longitudinal research is required.