Effect of Sublingual Application of Cannabinoids on Intraocular Pressure: A Pilot Study

Purpose: The purpose of this study was to assess the effect on intraocular pressure (IOP) and the safety and tolerability of oromucosal administration of a low dose of delta-9-tetrahydrocannabinol (D-9-THC) and cannabidiol (CBD).

Patients and Methods: A randomized, double-masked, placebocontrolled, 4 way crossover study was conducted at a single center, using cannabis-based medicinal extract of D-9-THC and CBD. Six patients with ocular hypertension or early primary open angle glaucoma received a single sublingual dose at 8 AM of 5 mg D-9-THC, 20 mg CBD, 40 mg CBD, or placebo. Main outcome measure was IOP. Secondary outcomes included visual acuity, vital signs, and psychotropic effects.

Results: Two hours after sublingual administration of 5 mg D-9-THC, the IOP was significantly lower than after placebo (23.5 mm Hg vs. 27.3 mm Hg, P = 0.026). The IOP returned to baseline level after the 4-hour IOP measurement. CBD administration did not reduce the IOP at any time. However, the higher dose of CBD (40 mg) produced a transient elevation of IOP at 4 hours after administration, from 23.2 to 25.9 mm Hg (P = 0.028). Vital signs and visual acuity were not significantly changed. One patient experienced a transient and mild paniclike reaction after D-9-THC administration.

Conclusions: A single 5 mg sublingual dose of D-9-THC reduced the IOP temporarily and was well tolerated by most patients. Sublingual administration of 20 mg CBD did not reduce IOP, whereas 40 mg CBD produced a transient increase IOP rise