Cbd oil for optic neuritis
by Vanessa Caceres
EyeWorld Contributing Writer
Many ophthalmologists have fielded questions about marijuana use and eye health, particularly if they are in a state where medical marijuana is legal.
Now, expect to get questions about a specific component of cannabis that’s growing in popularity.
Cannabidiol, or CBD, is a chemical found in the cannabis plant. It does not make users “high,” and it has been used by many as an oil or infused into food, skin creams, and even gummies.
Under the 2018 Agriculture Act, hemp and CBD were made legal in all 50 states, although some in the medical field say there still is confusion over the specifics. Nonetheless, this has helped to set off a brigade of products and companies touting the health benefits of CBD. “This recent legislature significantly lightened the restrictions in industrial hemp, paving the way for CBD,” said Samantha Morrison.
Outside of the world of eyes, some researchers and patients have found some specific benefits for CBD. “Researchers have found that CBD has proven anti-inflammatory, antioxidant, anti-aging, and neuroprotective properties,” Ms. Morrison said. “As a result, more and more people are turning to the organic compound for treating a wide variety of ailments, including inflammation, anxiety, pain, nausea, and even neurologic disorders.”
“CBD and other cannabinoids have nice results in the reduction of anxiety and chronic pain. It is the workhorse of the cannabinoids. CBD is what does the work on reducing muscle spasms, pain, and inflammation,” said Mary Clifton, MD, who provides cannabis consultations in New York and through her virtual telemedicine portal.
In clinical trials, CBD has been shown to be an effective treatment for epilepsy, according to a report from the World Health Organization. 1 Last year, the U.S. FDA approved Epidiolex (GW Pharmaceuticals), a CBD-based drug designed to treat two rare and severe forms of epilepsy. Other CBD-based drugs are under development, including Arvisol (Echo Pharmaceuticals), which is in pre-clinical testing for epilepsy and schizophrenia.
On the consumer level, CBD users are reporting that they have found relief from sleep problems, inflammation, and stress and anxiety, according to Brenda Green, MEd. There are also many who purchase CBD oil for pet anxiety or inflammation, she added. Some parents are trying CBD for attention deficit disorder in their children.
The use of CBD is most effective as a tincture (placed under the tongue) or vaped, although some consumers dislike the idea of using a vape, Ms. Green said. Jordan Tishler, MD, cautions that research on CBD dosing has shown that you cannot vape enough to get an effective treatment.
Cannabidiol has few side effects. Some studies have noted fatigue, diarrhea, and change in appetite, but these are considered rare, Ms. Morrison said.
For the eyes
Ophthalmologists may wonder how all this comes back to eye health. Because marijuana has had a long-time association with glaucoma (even if scientific evidence does not back it), medical professionals and patients tend to ponder whether CBD also can improve eye health, be it for glaucoma or other ocular issues.
The bottom line: The evidence is mixed, and it’s likely too early for a clear answer.
A 2016 Canadian study of CB1 and CB2 receptors in monkeys concluded that manipulating the endocannabinoid system may help restore normal vision and protect the retina. 2
“In practice, cannabinoids help regulate the arterial tone within blood vessels in the central nervous system. This has led researchers to study the effect of cannabis on retina ischemia and retinopathy in general,” Ms. Morrison said. “Clinical trials indicate that cannabinoid receptor antagonists may inhibit cellular degeneration caused by the release of lactate dehydrogenase induced by retinal ischemia.”
A U.K. study that reviewed research on cannabinoids and glaucoma reported that because CBD has antioxidant properties not mediated by the CB1 receptor, it could prevent neuronal death by scavenging toxic reactive oxygen species produced by overstimulation of receptors for glutamic acid. 3 “Perhaps the potent antioxidant properties of the cannabinoids may be beneficial in [age-related macular degeneration], offering a possible alternative to established antioxidant supplements,” the authors wrote.
“Some publications have suggested that cannabinoids can be neuroprotective, so that has some implications for retinal diseases like retinitis pigmentosa. The results are mixed, and I would say contradictory,” said Alex Straiker, PhD.
A recently published study that received attention in the consumer press focused on both CBD and Δ9-tetrahydrocannabinol (THC, the main psychoactive ingredient in cannabis) and their role in regulating IOP. 4 “Over the last several years, we have determined that three different cannabinoid receptors—CB1, GPR18, and GPR119—each can lower pressure in mice when activated. Once this was established, it made sense to go back to THC and CBD to see how they act,” said Dr. Straiker, one of the study’s co-researchers. Their study provided topical application of both THC and CBD in mice, and researchers found the CBD actually raised IOP. At the same time, THC lowered IOP through a combination of CB1 and GPR18 receptors. The effect of THC was sex-dependent, with longer effects in male mice. Additionally, CBD canceled out the IOP-lowering effects of THC, probably by blocking CB1 receptors, Dr. Straiker said.
Between research and practice, for now, there is no CBD treatment recommended specifically for the eyes. “It is not an effective treatment for any ophthalmologic issues,” Dr. Tishler said. “Further, the high doses needed to see any result in illness are not achievable in eyecare.”
In her own review of the research, Dr. Clifton sees potential for CBD and certain eye health issues. “It makes sense that taken internally, it would help inflammation or pain syndromes affecting the eye, just like it does any tissue,” Dr. Clifton said. She perceived several of the previous studies conducted as biased against cannabis.
Research on CBD in the U.S. likely will expand now that it is no longer classified as a Schedule 1 drug, Mr. DeRose said (marijuana is still on the Schedule 1 list from the Drug Enforcement Act). One of many questions that could be explored with further research is what happens in subjects who smoke high-CBD varieties of cannabis, Dr. Straiker said.
Ophthalmologists can use their growing knowledge of CBD to guide patient queries appropriately, particularly in states where marijuana has been legal for a longer length of time.
“CBD is a very common topic of ongoing education throughout Colorado,” said Antonio DeRose. “This has helped reduce negative stigma and spread positive awareness for several medicinal properties, which in turn is leading more people to turn to CBD over certain prescriptions and over-the-counter medications.” However, Dr. Tishler said that this can be dangerous if done without regard to a patient’s actual medical care.
“At true treatment doses of 10–20 mg/kg, CBD can interact with conventional medications and depending on what those are, can be quite dangerous,” Dr. Tishler said.
Ophthalmologist Ray Chan, MD, receives one or two questions a month about CBD or marijuana, mostly from patients who have a stronger interest in alternative medicine. If patients are using CBD for systemic health, he advises checking with their primary care doctor to find out if it’s helpful. If it’s for eye health, “I would advise them that there is no scientific evidence that it helps the eye. There are many better and cheaper medications to treat glaucoma,” he said.
Dr. Tishler is asked frequently about CBD for sleep and pain relief, but he states the data only supports the use of THC/THC-dominant whole flower for these problems.
For those who want to delve deeper into CBD use, it’s important to learn more about dosing. Ms. Green advises CBD users to start “low and slow” but also noted that it’s easy to get the dosing wrong, which is why users should buy from retailers with extensive product knowledge. Product quality is also key. There are a lot of CBD products entering the market, but that does not necessarily mean they are all effective, Ms. Green said.
Dr. Clifton also recommends tinctures or vaping and steers patients away from edibles, which can take longer to be effective.
Marijuana use for glaucoma not effective
Although there’s a common perception that marijuana can help lower IOP, that is not a formal recommendation from ophthalmologists.
“We have known since 1971 that smoking marijuana does lower your eye pressure, which is the main treatment for glaucoma. However, the eye pressure lowering effect is very short acting,” Dr. Chan said. For someone to achieve a sustained IOP lowering, they need to constantly use the drug, which could lead to systemic changes to the brain, lungs, and cardiovascular system, he explained.
Cannabis for glaucoma “is entirely impractical and dangerous,” Dr. Tishler said.
In a 2014 paper, the American Academy of Ophthalmology said there is no evidence that marijuana provides an increased benefit for or diminished risk of glaucoma compared to the traditional treatments available. 5
About the sources
Ray Chan, MD
Texas Health Arlington
Mary Clifton, MD
Internal medicine physician
Antonio DeRose, NASM CPT
Green House Healthy
Brenda Green, MEd CBD specialist
Alex Straiker, PhD
Senior research scientist
Department of Psychological and Brain Sciences
Jordan Tishler, MD
President, Association of Cannabis Specialists
Harvard Medical School
- World Health Organization. Cannabidiol: Pre-review report. November 2017. www.who.int/medicines/access/controlled-substances/5.2_CBD.pdf
- Bouskila J, et al. Cannabinoid receptors CB1 and CB2 modulate the electroretinographic waves in vervet monkeys. Neural Plast. 2016;2016;1253245.
- Tomida I, et al. Cannabinoids and glaucoma. Br J Ophthlamol. 2004;88:708–13.
- Miller S, et al. Δ9-tetrahydrocannabinol and cannabidiol differentially regulate intraocular pressure. Invest Ophthalmol Vis Sci. 2018;59:5904–5911.
- AAO Complementary Therapy Task Force, Hoskins Center for Quality Eye Care. Marijuana in the Treatment of Glaucoma CTA – 2014. June 2014. www.aao.org/complimentary-therapy-assessment/marijuana-in-treatment-of-glaucoma-cta–may-2003
CBD & the Eyes: Research & Can It Help You?
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CBD has become a touted treatment for various issues, including glaucoma. This is based on older medical studies and anecdotal reports that CBD oil, eye drops, and other forms of medical marijuana help to ease anxiety, eye strain, and eye pressure.
One of the first studies on medical marijuana for eye conditions involved glaucoma. This is a group of serious eye disorders associated with damage to the optic nerve, usually due to high fluid pressure in the eye, or intraocular pressure (IOP). This pressure must be lowered to prevent blindness. Further studies of medical marijuana have found that the drug does not actually lower pressure for long enough.
The United States Food and Drug Administration (FDA) has approved CBD for some very limited medical uses, and several states have legalized both medical and recreational use of marijuana, both THC and CBD.
Dispensaries recommend CBD for eye treatment, especially glaucoma. Medical research has found that medical marijuana does not lower eye pressure for more than three or four hours, which is not long enough to prevent damage to the optic nerve. Paradoxically, it may increase the risk of damage due to fluctuations in eye pressure over the course of the day.
In fact, a recent medical study found that THC, not CBD, lowered eye pressure. By itself, CBD raises IOP, and in combination with THC, it can prevent THC from lowering IOP. THC is the intoxicating, recreational chemical in marijuana, which can be addictive and cause problems with thinking or memory.
It is important for you to follow medical advice from your optometrist and ophthalmologist to manage all eye conditions, from dry eyes to glaucoma. Don’t attempt to self-treat any eye issue with CBD.
Table of Contents
Cannabidiol (CBD) & Your Eyes: High Intraocular Pressure Is Dangerous
Glaucoma is a group of related eye conditions involving damage to the retina and optic nerve that leads to vision loss, typically due to high fluid pressure inside the eyes. Symptoms tend to start slowly until enough of the optic nerve is damaged that the person develops tunnel vision or another form of lost vision. Regular eye exams can help to diagnose glaucoma or high ocular pressure, so an optometrist or ophthalmologist can monitor this progression and ensure you receive appropriate treatment if you begin to lose your sight.
Treating glaucoma starts with medicated eye drops that are designed to lower intraocular pressure. If these do not work, there are several approaches to surgery that can lower fluid pressure in the eyes and prevent vision loss.
There are side effects to all these options, so many people with glaucoma, or who are at risk for glaucoma, want to find alternatives. One proposed alternative is CBD oil, or the cannabidiol molecule derived from medical marijuana.
Using Medical Marijuana Like CBD for Your Eyes Does Not Work
As marijuana has become more popular and many states have legalized both medical and recreational uses for this drug, CBD oil is being promoted for a range of uses, including as a glaucoma treatment.
There are very few medical studies on the effectiveness of CBD or medical marijuana, although the United States Food and Drug Administration (FDA) has information on potentially beneficial uses for this approach to treatment. They have approved one CBD-based drug for two types of severe, rare epilepsy. Some forms of medical marijuana have been examined to treat eye conditions, especially glaucoma, but newer research suggests that CBD is not an effective treatment for your eyes.
Medical marijuana has been touted to generally ease physical and emotional pain, including nausea related to cancer treatment, chronic pain, general anxiety disorder, and other conditions. In the 1970s and 1980s, medical marijuana was studied as an eye treatment, particularly for serious conditions like cataracts and glaucoma, which can lead to blindness. The research found that marijuana could lower intraocular pressure for three or four hours at a time, and it was more effective at lowering pressure in the eyes than glaucoma drops.
However, the studies also found that these pressure-lowering effects would wear off after a certain amount of time, while the effects of glaucoma eye drop treatment lasted at least 12 hours. It is vital for eye health that treatment to manage intraocular pressure lasts for a long time and is consistent. When eye pressure rises and lowers several times throughout the day, damage to the optic nerve can get worse.
Medical Studies on CBD & the Eyes Suggests CBD Is a Dangerous Chemical
CBD in particular is receiving a lot of attention from the medical community and medical marijuana proponents. However, studies suggest that the CBD compound may make intraocular pressure higher, while THC (tetrahydrocannabinol), the chemical in marijuana associated with substance abuse and getting high, is responsible for lowering eye pressure.
A study conducted in 2018 found that THC and CBD regulate eye pressure differently. When they are separated from marijuana, they will have radically different effects.
The results of the 2018 study found that a single dose of THC drops lowered IOP by 28 percent for 8 hours in male mice, although humans with glaucoma need 24-hour pressure relief to reduce damage to the optic nerve. The study also found two interesting problems. First, CBD inhibited THC from lowering IOP. Second, the effects of THC on eye pressure were sex-dependent, with male mice receiving noticeably greater benefit from the treatment.
- Accelerated heartbeat, which can trigger anxiety or feel like anxiety.
- Decreased blood pressure overall, which can be harmful to the cardiovascular system.
- Reduced blood flow to several parts of the body, including the optic nerve, which can increase damage.
- Increased risk of lung cancer specifically from smoking or vaping marijuana products.
- Greater risk of addiction with any amount of marijuana treatment containing THC.
- Drowsiness, memory loss, and cognitive issues associated with abusing marijuana.
- Struggles to hold down a job or drive safely if drug-tested.
Most medical research suggests that CBD does not intoxicate you the same way THC does, but taking types of medical marijuana marketed as “high CBD” might mean there are traces of THC included in the substance. THC is addictive because it can change brain chemistry to make you feel relaxed, less anxious, sleepy, or even happy. The drug can also cause negative side effects like changes in mood, spikes in anxiety or paranoia, delusions, and trouble thinking or problem-solving.
Follow Your Eye Doctor’s Treatment Plan for Treating Eye Conditions
Some dispensaries hype CBD for the eyes aside from glaucoma treatment, suggesting that it can ease pain from surgery, reduce dry eye, and even alleviate eye strain. However, there are no medical studies to back up these claims. The changes to eye pressure due to CBD may lead to damage to your vision, even if you do not have glaucoma.
The only currently approved medical approach for glaucoma is regular eye exams to monitor the condition. Follow your eye doctor’s advice to manage this condition if you are diagnosed with it. This will likely mean eye drops first to prevent vision loss. It could also mean laser eye surgery, drainage devices, or other types of surgery to alleviate intraocular pressure and reduce damage to the optic nerve.
Glaucoma. (July 2020). National Eye Institute (NEI).
Cannabidiol (CBD) – What We Know and What We Don’t. (August 2018). Harvard Health Publishing, Harvard Medical School.
Is There a Risk of Blindness With CBD? (2018). United States Food and Drug Administration (FDA).
CBD Oil May Worsen Glaucoma. (February 2019). American Academy of Ophthalmology (AAO).
What Is Marijuana? (December 2019). National Institute on Drug Abuse (NIDA).
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CBD Oil And Optic Neuritis
Has anyone had any success using CBD oil to treat optic neuritis? That is my most bothersome symptom, everything else I can live with!
Use it for MS symptoms. I also use edible cannibus
Been using cannibus for years the best help of all. Good luck.
I use CBD to relieve pain, so it may be helping with the pain of optic neuritis. I find that the addition of THC to the CBD oil helps relieve spasms.
I use CBD to treat pain, so it may be relieving the pain of optic neuritis. I find that THC is the only thing that treats spasms, so I use an CBD/THC oil.
I told myself in the beginning i had problems that make me a little ecocentric
Then just take pills for disability. It caught up with! Ouch! Just sharing have a great day