Systemic hypotension exacerbates the progression of normal pressure glaucoma. We present a female patient with glaucomatous disc changes in the setting of inconspicuous tonometry. Failure of the adrenal gland, thyroid and pancreatic islet cells (Schmidt-Carpenter syndrome) likely formed the basis of the ocular pathology. This clinical constellation provided the chance to influence disease progression by raising the nocturnal blood pressure in addition to lowering intraocular pressure.