Ocular side effects from herbal medicines and nutritional supplements.
OBJECTIVE
To review the more significant herbal and nutritional agents of clinical importance to ophthalmologists and describe the ocular side effects for each. World Health Organization (WHO) classification and guidelines for clinicians are provided.


METHODS
Retrospective observational case series.


METHODS
A retrospective observational case series of reports of ocular side effects or systemic side effects from medications used for the eye from herbal medicines and nutritional supplements. Cases were collected from spontaneous reports submitted to the WHO, the Food and Drug Administration, and the National Registry of Drug-Induced Ocular Side Effects. A review of the world's literature was performed to obtain additional case reports and insight into adverse ocular reactions. Data were collected on age, gender, duration of therapy, concomitant medications, dosage, and dechallenge and rechallenge results.


RESULTS
The National Registry of Drug-Induced Ocular Side Effects received 263 spontaneous reports, in addition to 60 case reports from the literature. Canthaxanthine, chamomile, Datura, Echinacea purpurea, Ginkgo biloba, licorice, niacin, and vitamin A are all associated with clinically significant ocular side effects.


CONCLUSIONS
Herbal medicines and nutritional supplements can cause ocular side effects. Clinicians need to recognize these adverse events, because a large segment of the population uses them, many times without the treating physician's knowledge.
Fraunfelder
Frederick W
FW
Casey Eye Institute, Oregon Health and Science University, Portland 97239-4197, USA. eyedrug@ohsu.edu <eyedrug@ohsu.edu>
D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems / Q000706:statistics & numerical data; D002675:Child, Preschool; D019587:Dietary Supplements / Q000009:adverse effects*; D005128:Eye Diseases / Q000139:chemically induced*; D005260:Female; D006801:Humans; D008297:Male; D008517:Phytotherapy / Q000009:adverse effects*; D028321:Plant Preparations / Q000009:adverse effects*; D012042:Registries; D012189:Retrospective Studies; D014481:United States; D014486:United States Food and Drug Administration; D014944:World Health Organization
D028321:Plant Preparations