IU School of Optometry Continuing Education
Systemic Pharmaceuticals

Part 3: Things patients give themselves

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Go to: Systemic Pharmaceuticals CE table of contents

URL: http://www.opt.indiana.edu/ce/syspharm/part3.htm
Revised: June 23, 2009
IU Optometry home page: http://www.opt.indiana.edu/
Comments (content): Dr. Brad Sutton at brsutton@indiana.edu
Comments: Web Administrator
Copyright © 2009, The Trustees of Indiana University

Ginkgo Biloba

Ginkgo biloba is the number one herbal product on the market. It is used to improve memory and cognitive functioning.

Ginkgo biloba increases blood flow and has direct antiplatelet activity, so it promotes bleeding. Be sure to caution patients if they admit to taking it and are on aspirin or prescription blood thinners. Ocular side effects (hyphema, retinal hemorrhages, NVD-/NVE-/NVI-induced hemorrhages) are related to bleeding.

Theoretically, Ginkgo biloba provides ocular benefits in glaucoma and AMD by improving blood flow; however, there is little supportive evidence.

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Niacin

 

Niacin is used to lower triglyceride and cholesterol levels and for several other unproven folk remedy applications.

A host of reported ocular complications can occur; the most serious of which is cystoid macular edema (CME) with decreased vision (does not have typical appearance on IVFA). It is usually seen only with 3 grams or more per day and the CME resolves with discontinuation.

 CME
CME photo

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Chamomile

Chamomile (flower) is contained in certain tea products and used as an anxiolytic. It is a folk remedy for ocular infections, etc. Chamomile causes a conjunctivitis when applied topically.

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Echinacea

Folk remedy for viral upper respiratory and eye infections. Like Chamomile, Echinacea causes a conjunctivitis when topically applied.

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Marijuana

Marijuana lowers IOP. Patients have an amazing knowledge of this! Up to 25% reduction can occur for up to 4 hours. It is less effective over time. Obvious problems with use.

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Datura (Jimson)

Datura stramonium, or Jimson weed, is common in the southwestern US. The seed pod and other parts of the plant contain scopolamine and atropine. Dried leaves of the Jimson weed are used in folk treatments for asthma, bronchitis, and coughs. It is also used as a hallucinogenic abused for recreational purposes. There is also an ornamental plant, Angel's Trumpet, that is in the Datura family that can cause the same ocular side effects.

Ocular side effect is cycloplegia/pupil dilation.

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Canthaxanthine

Canthaxanthine is an oral bronzing/tanning agent naturally occurring in crustaceans, some mushrooms, and some pink fish. It is now produced in the US and more readily available. Canthaxanthine is prescribed occasionally for Vitiligo and extreme photosensitivity.

Canthaxanthine causes a classic deposition of crystals in the retina with a ring pattern surrounding the macula. It is almost always asymptomatic. Crystals resorb over time after discontinuation. 60 grams daily = 100% chance of retinal deposits.

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Licorice

Licorice root is a folk treatment for stomach problems and URIs. It contains the isoflavanoid glabardine which has antinflammatory and antiplatelet properties.

Licorice root can cause vasospasms that lead to transient vision loss or retinal migraine-like symptoms with no headache. These symptoms occur only after ingestion of large quantities.

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