Time (fiours)

is associated with increased outflow facility.61 In addition to increased outflow facility, THC may cause reduced perfusion pressure to the ciliary body, decreased aqueous formation, a central nervous system effect, and both alpha- and beta-adrenergic effects in the eye.58 In a single glaucoma patient studied in detail, the predominant effect observed was increased uveoscleral outflow, with a small effect on outflow facility.62

Marijuana has been designated a schedule I compound classified as having no medical benefit. Smoking cannabis or oral administration of THC does not seem a reasonable recommendation to make for patients with glaucoma, many of whom are elderly. There are many other alternatives to marijuana for reducing IOP with fewer attendant side effects. Although cannabinoid analogs have been tried, most have been limited by adverse effects or inconsistent clinical effects.58-61 In general, attempts at topical application of cannabinoids have been unsatisfactory because of ocular irritation and other side effects or lack of effect on IOP,58,63 although it may be possible to develop improved compounds and formulations in the future.59

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