The Truth About The Use of Medical Marijuana for the Treatment Of Glaucoma.

Due to the growing legalization of medical marijuana debates, there have raised many questions over the uses of Marijuana for the treatment of Glaucoma. It has also caused many patients who use marijuana for recreational use to talk to their ophthalmologist about their own prevention of glaucoma.

First, we have to understand the background….

In terms of treatment of glaucoma, a patient MUST have 24 hour coverage of eye pressure lowering effects. Basically, if a patient were to have Glaucoma, and they were to use an eye drop that lowers the eye pressure for only 8 hours, that means that the patient is still walking around with elevated eye pressure for 16 hours during the day. That is not only poor coverage, but it is actually MORE dangerous than not treating it at all. You see, under-treating eye pressure causes even greater fluctuations in eye pressure than had it been left alone. This is extremely dangerous for Glaucoma patients.

What is Glaucoma? Glaucoma is an eye disease that causes progressive, painless visual loss, which if goes undetected, will lead to total blindness. It is the #2 cause of irreversible blindness in the USA. There are many risk factors which can lead to or even worsen Glaucoma, however the most popular risk factor is an elevated eye pressure. This is why billions of dollars or research has lead to multiple surgical procedures and countless medications, which are aimed strictly to lower eye pressure.
What is Marijuana? Marijuana is a natural plant that grows in the ground. It has multiple medicinal/recreational uses which are derived from 2 active ingredients in Marijuana. Active Ingredient #1- THC (tetrahydrocannabinol) THC is the portion of the Marijuana plant that causes euphoria, or “getting high” sensation, slowed reflexes, increasing hunger, and in some instances hallucinations. Active Ingredient #2- CBD (cannabidiol) CBD causes relaxation, and pain relief

How has Marijuana been linked to Glaucoma? In 1971, a study came out showing that marijuana lowers the eye pressure. After this study, marijuana has been labeled as the natural miracle plant for treatment of glaucoma. The only problem is, the study never stated which active ingredient lowered the pressure, and it also did not state how long the effect would last.
Now that you have the background, lets tackle the newest study done at the University of Indiana in 2018. They tested the effects of each one of ingredients (THC and CBD) on eye pressure when used alone, as well as when used together. What they found was astonishing, but shocking.

They tested an eyedrop with CBD, the component of cannabis that does not get you stoned, and they found that it RAISED EYE PRESSURE by 18 percent for at least four hours after the drops were instilled. They also tested THC, the component that does get you stoned, and they found that drops containing only THC decreased eye pressure by up to 30 percent within eight hours. They then tested an eye drop with BOTH CBD and THC and found that due to the counteracting effects of CBD vs THC, marijuana does lower eye pressure, but for a very short amount of time.

What does this mean? This means that although CBD has many medicinal positive effects, it should be used in extreme caution! Patients with Glaucoma should NOT use CBD as it will likely increase the patient’s eye pressure. If used for an extended period of time, it can lead to glaucoma in patients at risk, who normally would not have developed glaucoma.

While it’s true that smoking marijuana can reduce pressure inside the eye, it remains a suboptimal treatment because people with glaucoma require 24-hour pressure control to prevent vision loss. You would need to smoke marijuana 8 to 12 times a day, every single day of your life; a treatment regimen that would make it difficult to hold down a job, drive, or function, not to mention the potential cost. The potency of marijuana also varies considerably. It is also unknown yet how it interacts with other medications. One study showed that some people can build up a tolerance to marijuana’s eye pressure lowering effects.

This is the reason why the American Academy of Ophthalmology and the American Glaucoma Society do not recommend using marijuana for treatment of Glaucoma. However, these studies released by the University of Indiana have had eye opening detrimental effects of CBD on eye pressure. CBD is readily available, legally, at pharmacies and the internet without prescriptions, but please use it in caution and speak to your eye doctor about whether the benefits you are seeking from CBD can be used safely with YOUR eye status. YOUR eye is not the same as your friend, parent or sibling’s eye, so please don’t use what an eye doctor tells your friend/parent/sibling and assume it pertains to you too.

Tea anyone? Treatment for styes and Chalazia

Almost every single day, our office has at least one, if not more, patients who present with a “stye.” A stye to the layperson is a red bump on the eyelid, however, in medical terms, it has a very specific meaning and diagnosis.

Either way, most patients who present with a stye, actually have a chalazion. What is the difference?

A stye, or in medical terms “a hordeolum,” is an infection and inflammation from a sweat gland, usually at an eyelash root. They can be medium sized or small, painless or painful, but the location is the key to diagnosis.

A chalazion is a blockage (but NOT necessarily an infection…..this is a big difference!) of large glands in your eyelids that secrete oil. They are called Meibomian Glands. Since they are large glands to begin with, you can imagine that if it becomes blocked, these “eyelid bumps” can become extremely large. If you have a large red bump on your eyelid, it is likely a chalazion and not a stye.

So now that you know the difference between  the two, the next step is treating it.

At least 2-3 times a week, I have a patient tell me that they used TEA BAGS on their eyes and the bump did not go away. Let me be the first to tell you, TEA BAGS ARE VERY BAD IDEAS AND ARE VERY DANGEROUS!!  So why did this person use it? Why have you heard that tea bags are good for styes and bumps? So to give you the answer to that, we have go back in time, prior to very common medications and eye drops. Back in the day, they used to heat up chamomile leaves and place it on the eyelids to treat these bumps. Guess what? It worked great!! However, heated tea leaves in the past, has now changed to heated tea bags in modern day times. This is INCORRECT!! You see, although heated tea leaves worked great back then, it actually wasn’t the tea itself. In reality, it was actually just the HEAT ALONE. If they used warm water, or warm rice, it would have worked just the same. Heat is the most common, and least expensive form of treatment for both styes and chalazia. So now back to the tea bags….unfortunately, you would assume that heated tea bags would work too, however, there is one big problem with the tea bags. You see, the tea bags are dipped in scorching hot water. When placed on the eye, it literally causes a burn to the eyelid skin. Even worse, when the hot water gets between the eyelids, it then causes a thermal burn to the cornea, which not only can be extremely painful, but can cause blindness and even require corneal transplants. This is why hot tea bags is NEVER an acceptable form of treatment for styes or chalazia.

So what are your options for treatment?

In terms of styes, warm compresses are often key to the treatment. It not only opens the orifice of the blocked gland to expel  the bacteria, but it also increases blood flow to the area, allowing your natural body defenses to come to the rescue and allowing antibiotics to readily flow to the area. Sometimes, styes may need to be opened which is very simple to do. Some styes don’t even need anesthetic and can be opened at the slit lamp. Occasionally, antibiotics (topical and/or oral) may need to be prescribed as well.

For chalazia, once again, warm compresses are the mainstay of treatment for all the reasons we listed above. Sometimes, since it is not infectious, it is all you may require. Sometimes, chalazia may need to be opened and excisedThis is an office procedure that requires topical anesthesia (like a lidocaine injection). The entire gland is removed. The incision is made on the inside of the eyelid, so there is less likelihood for scarring. Topical steroids are sometimes used to reduce the inflammation, which decreases the pain and allows the orifice to drain. Occasionally, steroid injections are used to slowly shrink the chalazion away over the course of a few weeks. Lastly, commonly, such as in children, no treatment may be necessary and it will often slowly go away on its own without treatment or surgery. That is a decision to be made between the ophthalmologist and the patient or parent.

In terms of prevention or decreasing the likelihood of recurrence, keeping the eyelashes clean is key. This is best achieved the keeping your hands clean and not touching your face if possible. Also, baby shampoo can be used to scrub the eyelashes clean and it works really well.

If you are concerned that you have a stye and/or chalazion, please go see an ophthalmologist right away. Delaying treatment will make the medical treatment less likely to work, and more likely it will either be a chronic condition or require surgery. Please, do not assume you have a stye or chalazia, because self diagnosis can be dangerous too. Get it checked out in case it is something else. Also, when you use warm compresses, please make sure NOT to burn yourself. It does not have to be scorching hot, just warm is fine.

I hope this helps with putting the myth of chamomile tea bags to rest and helped you learn a little more about styes and chalazia. Friends don’t let friends put teabags on their eyelids.