When used as part of an integrative approach, herbs and herbal formulas can help manage glaucoma in dogs. 

Glaucoma in dogs can be a serious emergency. It can result in permanent vision loss in the diseased eye(s), in spite of the best ophthalmological care. Herbs can be helpful in managing a patient with glaucoma, but they should be used at a secondary or tertiary level of care, with pharmaceuticals, to help bring the patient into balance and create better intraocular eye pressure (IOP). Herbal therapies can also reduce the potential of side effects from the topical and systemic glaucoma medication administration.

In the dog, glaucoma can take many forms.

1. It can manifest slowly and chronically with slight reddening of the eye, and slight increases in IOP that aren’t enough to create the typical bulged-eye appearance. As the pressure inside the eye increases, the blood supply to the eye decreases and the oxygen-hungry nervous tissue in the eye begins to die. If the increasing IOP is left unchecked, permanent blindness will result.¹
   
   My own dog, Trigger, an eight-year-old Chocolate Lab, suffered from glaucoma. I adopted him shortly after his first enucleation, and suffered with him through his second enucleation. A hard-of-hearing, 95-pound dog with poor hips and knees was a challenge to care for through 18 months of adapting his life and my house to his permanent blindness.

2. Glaucoma can also have a sudden onset. This acute form can cause rapid loss of eyesight before one can get the dog seen by a veterinarian trained in pharmaceutical or laser/surgical interventions for this disease. With Trigger, even I didn’t know his second eye had lost its sight and gone acutely glaucomatous until he started bumping into walls.Anything we can do to keep the eye intact, with normal vision and no pain, is a success story.

Herbs for glaucoma

1. Cannabis sativa L.

Studies in both cats and humans have demonstrated the effectiveness of cannabis for lowering IOP.

Feline study²

A group of researchers from the Departments of Ophthalmology and Pharmacology & Toxicology at the West Virginia Medical Center published a study in 1984 involving 55 adult cats. In the first part of the study, they measured the cats’ IOP one hour before, immediately after, and at hourly intervals for six hours following the topical application of the cannabinoids – cannabinol (CBN) and cannabigerol (CBG). They applied the drops to one eye, and measured the IOP of both eyes in order to use the contralateral eye as each animal’s control.

Three hours after a single application of 1 mg of CBN to the cats’ eyes, the researchers measured a significant reduction in IOP from the baseline value. The lower dose of 500 mcg did not significantly change the IOP. The IOP reduced from 23.5+/2.5 mmHg to 18.7+/0.3 mmHg with a topical ophthalmic dose of 1 mg CBN.

In the second part of the study, the researchers measured the IOP daily for 12 days. The cats were hooked up to mini-pumps to deliver a constant rate infusion of cannabinoids into their eyes. (I hate these kinds of invasive experiments on pets.) This allowed the investigators to see what ocular toxicity would arise from long-term daily administration of topical ophthalmic drops containing the CBN and CBG.

Throughout the period of chronic administration, the eyes remained 4 mmHg to 6 mmHg lower than the untreated contralateral eyes. The effect on the treated eyes wore off after the cessation of drops for three days.

Human study³

A more recent study, published in 2006 in the October issue of the Journal of Glaucoma, found that human patients also experienced a significant change in IOP two hours after the administration of sublingual drops containing 5 mg of ∆-9 Tetrahydrocannabinol (THC). The IOP was significantly lower than after placebo – 23.5 mmHg vs 27.33 mmHg (p=0.026), and stayed that way for about three hours after administration before returning to baseline. Cannabidiol (CBD) was given in the same fashion at 20 mg and 40 mg doses. The higher dose produced a transient elevation of IOP four hours after administration.

Of course, the use of cannabis comes with this caveat: in the 24 states that have passed medical marijuana laws, not one allows the legal prescribing or dispensing of cannabis by a veterinarian. So please stay in compliance with the laws of your state, and work democratically for the rescheduling of Cannabis sativa L. to a lower Controlled Substance classification than its current Schedule One classification.

2. TCVM Formulas

The true value of TCVM lies in its ability to effectively address the individual characteristics of a disease manifestation in a patient using an individualized formula. There are a number of effective formulas for patients with glaucoma. The best way to determine which one to use involves taking a TCVM exam, using tongue evaluation, pulses, palpation, and asking questions about the characteristics of the patient (behavior, temperature preferences, times of day when better or worse, food desires and aversions, etc.) Dozens of formulas could apply, depending on the individual presentation.

• Acute glaucoma often benefits from the Gentiana formula, which can help until the veterinary ophthalmologist appointment and can be used concurrently with pharmaceuticals. Typically, this dog will have reddened, injected sclera with prominent veins. The eyes may be visibly bulging, and if you press over the eyelid, it may be painful and feel quite turgid. Irritability may also be present.

One TCVM diagnosis for glaucoma is Liver Fire Rising, causing red eyes (Liver rules the eyes) which will cause the glaucoma. It may be associated with headaches and even convulsions, depending on how severely Liver Fire is present in a patient.

Long Dan Xie Gan Tang (Gentiana Decoction to Drain the Liver),^4,5,6 contains raw rehmannia root, dang gui root, gentian root, alisma tuber, akebia, bupleurum, plantain seed, licorice root, scutellaria root and gardenia root. These herbs are very “cooling” and help drain dampness from bulging eyes if the dog’s symptoms match the TCVM prescribing criteria for Gentiana. This formula has a very strong anti-inflammatory activity.

– Scutellaria, gardenia and gentian roots are very bitter and quite anti-inflammatory.

– Akebia, alisma tuber and plantain seeds are diuretic.

– Bupleurum and scutellaria address the liver heat directly, helping to constrain the Liver Fire from rising.

– Raw rehmannia root helps cool the blood.

• Chronic glaucoma can be treated with three TCVM formulas in patients who present with a deficiency profile. Remember that there are many different combinations, again depending on the individual’s TCVM evaluation. Deficiency patients may be deficient in Liver Blood and/or Kidney Yin, creating a deficiency heat that can affect the eyes.

1. Gastrodia and Uncaria Formula (Tian Ma Gou Teng Yin)^7,8,9 is a deficiency formula that contains haliotis (conch shell). The calcium carbonate in the shell is very cooling. The main herbs in the formula, gastrodia and uncaria, are meant to reduce the rising Yang from the liver with deficient Blood and Yin. As with Long Dan Xie Gan Tang, gardenia and scutellaria clear heat from the upper part of the body, and are calming as well. Other herbs in this formula help moisten Yin, move the Blood, and bring the Yang back to where it belongs. The rest of the herbs are calming, and help support the balance between Yin and Yang. This formula is also used for deficiency seizures in which Liver Blood deficiency creates an upwards moving Liver Wind resulting in the seizure. It also brings Heat to the eyes, resulting in redness and possibly glaucoma.
2. Dendrobium Pill for Night Vision (Shi Hu Ye Guang Wan)¹⁰ is a large formula with 25 herbs for soothing the Liver and calming Liver wind. It also will nourish Yin and brighten vision. This formula is for the patient with Liver and Kidney Yin deficiencies leading to the rise of internal Fire and Wind, impaired vision, photophobia, red and painful eyes, a cloudy lens and tearing.

The 25 herbs in this large formula can be grouped into five categories of action:

– Nourish Blood and generate body fluids – dendrobium, ophiopogon, asparagus root, rehmannia root both cooked and raw, and schizandra

– Nourish Yin and Tonify Liver and Kidney Yin – cuscuta, lycium fruit, achyranthes bidentata, cistanches

– Tonify the Lung and Spleen to allow for conversion of food Qi to Kidney Yin and Kidney Jing – ginseng root, poria, licorice root and honey

– Calm Internal Wind and Clear Heat – aurantium fruit, ligusticum wallichii, chrysanthemum flowers, cassia seed, saposhnikova root, tribulus fruit, and celosia seed

– Calm the Liver and Purge the Heart – Chinese coptis root

3. Ming Mu Di Huang San^11,12

The third deficiency formula is directed toward Kidney and Liver Yin and Blood deficiencies that result in deficiency heat rising to cause red eyes and glaucoma. The accompanying article by Dr. Margaret Fowler (see page 20) uses this formula to successfully treat a cat with glaucoma that failed to respond to pharmaceutical therapies.

The take-home message with glaucoma, from my own experience, is to not wait around for it to get better on its own. Regular eye pressure readings, and the use of pharmaceutical and herbal strategies to keep the IOP normal, need to be a daily to three times weekly event in order to provide vigilance against relapses and loss of eyesight.

References

¹Gelatt, K. Essentials of Veterinary Ophthalmology. Lippincott Williams and Wilkins, 2000:326-328.

²Colasanti BK, Craig CR, Allara DR. “Intraocular Pressure, Ocular Toxicity and Neurotoxicity after Administration of Cannabinol or Cannabigerol”. Exp Eye Res. 1984;39:251-259.

³Tomida I, Azuara-Blanco A, House H, Flint M, Pertwee RG, Robson PJ. “Effect of sublingual application of cannabinoids on intraocular pressure: a pilot study”. J Glaucoma 2006 Oct;15(5):349-53.

⁴Xie H, Preast V. Xie’s Chinese Veterinary Herbology, 2010. Blackwell Publishing; p.378-379.

⁵Chen JK, Chen TT, Beebe S, Salewski M. Chinese Herbal Formulas for Veterinarians. Art of Medicine Press 2012:277-283.

⁶Marsden S. Essential Guide to Chinese Herbal Formulas. College of Integrative Veterinary Therapies Publishers 2014:99-103.

⁷Xie H, Preast V. Xie’s Chinese Veterinary Herbology, 2010. Blackwell Publishing; p.505-507.

⁸Chen JK, Chen TT, Beebe S, Salewski M. Chinese Herbal Formulas for Veterinarians. Art of Medicine Press 2012:797-800.

⁹Marsden S. Essential Guide to Chinese Herbal Formulas. College of Integrative Veterinary Therapies Publishers 2014:138-141.

¹⁰Chen JK, Chen TT, Beebe S, Salewski M. Chinese Herbal Formulas for Veterinarians. Art of Medicine Press 2012:521-523

¹¹Chen JK, Chen TT, Beebe S, Salewski M. Chinese Herbal Formulas for Veterinarians. Art of Medicine Press 2012:518-520.

¹²Xie, H. Chinese Veterinary Herbal Handbook: 216 Most commonly Used Veterinary Herbal Formulas. 3rd Ed. 2012. Jin Tang Publishing, Reddick, Fl. P. 119.