Medical Marijuana and Glaucoma Treatment, Symptoms

Glaucoma is the name for several eye diseases that share the common trait of degeneration of the optic nerve leading to vision loss and eventual blindness. At the onset of glaucoma, symptoms may not be apparent. The types of glaucoma that affect adults are primary open angle glaucoma and angle closure glaucoma. Pediatric glaucoma may be diagnosed in children. Normal tension glaucoma is another type of glaucoma, characterized by vision loss despite normal IOP, and diagnosable only by examination of the optic nerve. The last kind of glaucoma is secondary glaucoma, which occurs after an eye injury, tumor, diabetes, or other eye condition weakens the optic nerve. For the treatment and management of all of these types of glaucoma, medical marijuana can be effective.

Medical marijuana’s primary benefit for glaucoma patients is its effect on intraocular pressure (IOP). In one study, more than 80% of patients who smoked marijuana using an ice-cooled water pipe experienced a reduction in IOP of 16-45%. Another study used cannabinoids contained in medicinal marijuana, and found a signficant drop in IOP in patients who took THC and cannabidiol. A third clinical trial also found that medical marijuana reduces intraocular pressure, as well as blood pressure overall.

The Leading Cause of Blindness

Glaucoma is the leading cause of blindness in the United States and despite a variety of medications available to treat the condition, some patients do not respond to conventional pharmacotherapy. The basic pathology of glaucoma is the increase in intraocular pressure due to over production of fluid in the eye, reduced resorption of the fluid and blocked drainage of the intraocular fluid. The result of the increased intraocular pressure is the reduction of retinal blood flow and ischemia.

CB2 Agonists Have No Effect

CB1 receptors are located in the ciliary body, Canal of Schlemm, choroid plexus and the retina. Administration of CB1 agonists topically and systemically lower intraocular pressure, CB2 agonists have no effect. Ocular tissue in normal eyes contains detectable CB1 endocannabinoids, those of glaucoma patients are deficient in measurable endocannabinoids in these same tissues.

CB1 agonists dilate and reduce pressure in the ciliary capillaries (which promotes resorption), they interfere with the ciliary body itself to reduce production of intraocular fluid by inhibiting calcium channels and norephinephrine, and by improving the drainage of the intraocular fluid through the canal of Schlemm.

In addition to the hydrostatic effects of cannabis on the intraocular fluid, CB1 receptors in the retina and available CB1 agonists are neuroprotective to the retinal. They work to preserve the blood/retinal barrier and may be useful in various retinopathies (diabetic retinopathy for example). There are few CB2 receptors in the eye and they effects of CB2 agonists are minimal.

    1. Finding of endocannabinoids in human eye tissues: implications for glaucoma.

(abst – 2005)

http://www.ncbi.nlm.nih.gov/pubmed/15823551

    1. Involvement of the Endocannabinoid System in Retinal Damage after High Intraocular

Pressure–Induced Ischemia in Rats (full – 2007)

http://www.iovs.org/cgi/content/full/48/7/2997?maxtoshow=&hits=80&RESULTFORMAT=

&fulltext=cannabis&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=

relevance&resourcetype=HWCIT

    1. The role of endocannabinoid system in physiological and pathological processes in the eye

(abst – 2008)

http://www.unboundmedicine.com/medline/ebm/record/19195174/abstract/%5BThe_role_

of_endocannabinoid_system_in_physiological_and_pathological_processes_in_the_eye%5D

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