CBD oil and glaucoma

by Apoorva Shivankar, M.D

cbd oil and glaucoma




  • A silent thief of sight.
  • No less than a coma of vision.
  • A real-sense hypertension of eye-ball (due to fluid and not blood).


  • Our magical Elixir.
  • Current top-notch of medicine world.
  • All-in-one solution for almost every ailment.

Can these 2 gels together? Can CBD prove its magic in Glaucoma management too?

Let’s dive into the details:


It is one of the leading causes of blindness across the globe with primary open-angle glaucoma as the commonest variety. Characterized by a cascade of events, glaucoma begins with a rise in intraocular pressure (IOP) as the ignition point. Normally, a fixed amount of fluid (aqueous humour) is maintained within the eye-ball by a controlled inflow and outflow routine across the trabecular meshwork. Any impairment in this routine can lead to accumulation and resultant hike in intraocular pressure. This raised eye pressure is not good for the ganglionic retinal cells which form the axons of the optic nerve, an essential bridge between eyesight and our brain.  Long term exposure to high eye pressure gradually weakens the nerve leading to glaucoma features like:

  • Blurred vision
  • Seeing halos around bright lights
  • Eye pain
  • Redness in the eye
  • Permanent vision loss

The unfortunate part is:

  • Once developed, the damage cannot be reversed.
  • 40% of sight is actually lost before a glaucoma patient notices any symptoms or seeks help.

The only way to treat glaucoma is by regulating the eye pressure on a 24-hour basis.

Cannabidiol (CBD)

CBD is the latest chemical supplement overwhelming the market with its widespread health benefits and patient-friendly product approach towards health problems. It soothes almost all your ailments and can be consumed in the way you prefer- you can ingest CBD as oil drops, capsules, or delicious gummies, use them as topicals or even vape or smoke them- the choice is yours. These CBD products with their flexibility and magnanimity of health effects are becoming the favorite of one and all.

Basics of Cannabidiol:

It is derived from the cannabis plant which contains more than 100 cannabinoids (THC and its cannabinoid cousin CBD being the predominant), variety of terpenes and flavonoids each having their own medicinal benefits.

This cannabis plant itself is of two varieties-

  1. CBD-rich hemp cannabis (<0.3% THC content)
  2. Psychoactive THC-rich marijuana cannabis (>0.3% THC content)

The story of Cannabis and Glaucoma dates way back in the 1970s

Credit goes to a 26-year-old glaucoma patient, Robert C. Randall who accidentally discovered that smoking marijuana relieves him of his glaucoma symptoms. He started cultivating cannabis at his place for which he was summoned and arrested as cannabis was and is an illegal drug. Later he proved his point in a court case and was granted permission to grow cannabis. This led to an entry of cannabis into the world of glaucoma but research was slow-paced due to the illegal stamp associated with it.

The very first study published by researchers Hepler and Frank in 1971 reported a 25-30% IOP lowering effect of smoking marijuana among a small number of participants. Few more studies done in the 1970s-1980s strengthened this positive effect of marijuana stating that smoking marijuana lower eye pressure significantly and delays the risk of glaucoma progression to vision loss by around 45%. 

Recently, the acceptance of the concept of medical marijuana and legalization of Hemp-cannabis accelerated the research in this direction. The upcoming research in the field of cannabis introduced us to an entirely new and very efficient ‘ENDOCANNABINOID SYSTEM (ECS)’, a diverse receptor system spread all over the body to regulate the homeostatic balance of our system. ECS is known to control pain, sleep, anxiety, mood, appetite, depression and many other aspects of the human body. It is through this system that marijuana expresses its potential benefits in glaucoma treatment too. Let’s see how?

A study published in the British Journal of Ophthalmology reported that even the ocular machinery is studded with cannabinoid receptors especially in the

  • Ciliary epithelium
  • Trabecular meshwork,
  • Schlemm’s canal
  • Ciliary muscle
  • Ciliary body vessels
  • Retina

The study conducted in mice in 2018 by Miller S et al confirmed that THC activates these cannabinoid receptors of the eyes (CB1, GPR18 and GPR119) to substantially reduce the intraocular pressure. Same study also indicated that this eye pressure-lowering effect of THC is gender-based being effective in males for a longer duration as compared to females.

Beyond the endocannabinoid effect:

  • Marijuana is also known to lower the eye pressure by its peripheral vasodilatory properties.
  • Neuroprotective role helps to prevent optic nerve damage.

Yes, it’s been proven that marijuana effectively lowers the intraocular pressure in normal as well as glaucoma patients and thus, theoretically can be used for glaucoma treatment, but practically its nowhere closer to the effectiveness of present-day medications available for the same purpose because

  • Actions of marijuana are temporary:

The effect of smoked marijuana stays for around four hours, indicating a compulsion of minimum 6-10 rounds of smoke per day to maintain the eye pressure round the clock. This can be difficult, routine disturbing and can also lead to deleterious side-effects in long term.

  1. Repeated use can raise the cost of treatment too.
  2. Smoking marijuana can reduce blood pressure which can actually reduce the blood flow to the optic nerve causing additional damage.
  3. Other forms like oral ones have lower bioavailability whereas topical ones being lipophilic show poor penetrability.
  4. THC has its own side-effects too
  • It can give you a high.
  • Can cause systemic side-effects such as rapid heart rate, decreased blood pressure, impaired judgment and coordination, impaired immunity, difficulty in memorizing, concentration, and many more
  • Even eyes can suffer from irritation, redness, ptosis, photophobia, nystagmus, decreased lacrimation, etc

These risk factors can easily outweigh the benefits of smoking marijuana in glaucoma patients taking it away from the mainstream glaucoma treatment plan.

Does CBD lower intraocular pressure?

The best way to retain the medicinal benefits and bypass the side-effects of marijuana is using Hemp-derived cannabidiol. Keeping this belief in mind, the scientists started working on cannabidiol role in Glaucoma management.

And then came the biggest disappointment:

Recent studies conducted in this field suggested that CBD can worsen glaucoma rather than benefitting it. A small human trial for cannabinoid effect in open-angle glaucoma performed in 2006 suggested that a 40mg sublingual dose of CBD oil can raise the eye pressure transiently after four hours of administration in contrast to no change in IOP with 20mg CBD or a significant fall in IOP as seen with THC after 2 hours. Later a study published by Miller et al, reported that administration of CBD oil eye drops in rat eyes raised the intraocular pressure by about 18% for as long as four hours which can further aggravate the condition and damage the nerve precipitating vision loss.2 This finding, combined with prior study in humans, compelled the American Academy of Ophthalmology to vote against the use of CBD by individuals at risk of glaucoma. 

To take it further Miller and other researchers also tested the effects of co-treatment with equal concentrations of THC and CBD and found that CBD blocked the pressure-lowering effects of its cannabinoid cousin THC. The mechanism by which CBD raises eye pressure is likely through antagonism of the CB1 receptors of ECS. THC activates CB1 receptors to lower pressure but CBD by acting as a negative allosteric modulator of CB1 signalling, masks THC effect. 

This was confirmed by checking the effects of CBD and THC in normal and CB1 knocked-out mice by Miller again, this time with topical CBD. As expected, THC lowered eye pressure significantly and CBD transiently raised it in normal mice, but not in CB1-knockout mice potentiating the role of CB1 receptors in glaucoma control.


Does all this make CBD sound like a villain in eye health?

Can CBD oil help with eye problems? In any form?

Yes, it does have some positive role to play. Let us check them out.

  1. Its anti-oxidant and neuroprotective power can help prevent, protect and delay optic nerve involvement in glaucoma.
  2. As a relaxant, CBD can improve the blood flow to the ocular tissue promoting their health, healing and survival.
  3. As an anti-inflammatory agent, CBD products can provide relief in general inflammation and other glaucoma symptoms too.
  4. Studies have shown that glutamate is the main culprit for retinal cells and neuronal damage in glaucoma. Glutamate facilitates the formation of peroxynitrite responsible for killing the neurons. Both THC and CBD by virtue of their antioxidant property hinder the formation of peroxynitrite protecting the neurons and thus, the vision for a longer period of time.

To conclude

Can CBD oil make glaucoma worse?

I would say, for now yes.


With only a smaller number of studies available, the research is still in infancy to declare CBD useless in Glaucoma management. An intense research is needed and who knows CBD may prove itself once again but till then, an eye doctor advises his patients to stay away from CBD and rely on the other available medications available for glaucoma.


Q. What medications should not be taken by glaucoma patients?

In case of Open-angle glaucoma, please avoid chronic use of oral steroids.

For Closed-Angle Glaucoma patients, following medications should be consumed with caution

  • Antihistamines and decongestants.
  • Asthma medicines.
  • Motion sickness medicines.
  • Tricyclic antidepressants.

Always consult your doctor before starting or stopping any medication.

Q. Can we put CBD oil directly in the eyes for instant relief from pain or redness?

No. Most of the CBD oils are lipophilic and do not dissolve in the aqueous environment of the eye. So, no effect. Special eye drops made as per ophthalmic environment and safety are available for this purpose.

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