9 Herbal medicine and dietary supplement induced ocular side effects

Herbal or supplement name: Canthaxanthine.

Primary use

This agent is used in cosmetics, as a food coloring and to produce an artificial suntan when administered orally. It is naturally occurring and is found in crustaceans and chanterelle mushrooms.

Ocular side effects

Systemic administration

Certain

1.Retina

a.Extracellular yellow or gold-like particles (Fig. 9.1)

b.Predisposed to macular area

c.Decreased retinal sensitivity

2. Blurred vision

3. Decreased dark adaptation

4. ERG

a.Hypernormal scotopic amplitudes (low doses)

b.Increased scotopic latencies (higher doses)

c.Depressed photopic activity

Clinical significance

For over two decades canthaxanthine has been known to cause deposition of a crystalline form of it in all layers of the retina, primarily the superficial layers. These may cover retinal blood vessels. There is a predisposition for deposition in the macular area, areas of prior trauma or areas of retinal pathology. The deposits are dose related, and may be more common in the elderly and patients with pre-existing ocular disease (i.e. glaucoma or pigmentary retinopathies). Chang et al (1995) described a case in which deposits significantly increased around a branch vein occlusion. The deposits will absorb with time if the supplement is discontinued, but this may take many years. In general, these crystals cause no visual problems, although in rare cases some visual complaints are seen. Static threshold perimetry. (Harnois et al 1988), dark adaptation, (Philipp 1985), and electroretinography (Weber et al 1987) can show abnormalities, which are reversible. If 37 g of canthaxanthine are given over time to enhance skin tanning, 50% of individuals will have retinal deposition, and at the 60-g level 100% will show retinal deposits (Harnois et al 1988). Harnois’ paper, along with Sharkey (1993) and cases in the National Registry, suggest that in sensitive individuals dietary intake may rarely show mild cases similar to those described here. There has also been canthaxanthine retinopathy without direct intake of canthaxanthine due to deposits from food coloring (Oosterhuis et al 1989). This naturally occurring carotenoid is a commonly used food color

and can be found in crustaceans, chanterelle mushrooms and in some pink-colored fish flesh. The most complete review of this subject is by Arden and Barker (1991).

References and Further Reading

Arden GB, Barker FM. Canthaxanthin and the eye: A critical ocular toxicologic assessment. J Toxicol Cut Ocul Toxicol 10(1&2): 115–155, 1991.

Arden GB, et al. Monitoring of patients taking canthaxanthin and carotene: An electroretinographic and ophthalmological survey. Hum Toxicol 8: 439–450, 1989.

Barker FM. Canthaxanthin retinopathy. J Toxicol Cut Ocul Toxicol 7: 223–236, 1988.

Bluhm R, et al. Aplastic anemia associated with canthaxanthin ingested for ‘tanning’ purposes. JAMA 264: 1141–1142, 1990.

Chan A, Ko TH, Duker JS. Ultrahigh-resolution optical coherence tomography of canthaxanthine retinal crystals. Ophthalmic Surg Lasers Imaging 37: 138–139, 2006.

Chang TS, Aylward W, Clarkson JG, et al. Asymmetric canthaxanthin retinopathy. Am J Ophthalmol 119(6): 801–802, 1995.

Cortin P, et al. Gold sequin maculopathy. Can J Ophthalmol 17: 103–106, 1982 (French).

Espaillat A, Aiello LP, Arrigg PG, et al. Canthaxanthine retinopathy. Arch Ophthalmol 113: 412–413, 1999.

Harnois C. Canthaxathine retinopathy. Anatomic and functional reversibility. Arch Ophthalmol 107: 538–540, 1989.

Harnois C, et al. Static perimetry in canthaxanthin maculopathy. Arch Ophthalmol 106: 58–60, 1988.

Leyon H, et al. Reversibility of canthaxanthin within the retina. Acta Ophthalmol 68: 607–611, 1990.

Lonn LI. Canthaxanthin retinopathy. Arch Ophthalmol 105: 1590, 1987. Oosterhuis JA, et al. Canthaxanthin retinopathy without intake of

­canthaxanthin. Klin Monatsbl Augenheilkd 194: 110–116, 1989. Philipp W. Carotinoid deposits in the retina. Klin Mbl Augenheilk 187:

439–440, 1985.

Sharkey JA. Idiopathic canthaxanthine retinopathy. Eur J Ophthalmol 3(4): 226–228, 1993.

Weber U, Goerz G. Carotinoid-Retinopathie. III. Reversibilitat. Klin Mbl Augnheilk 188: 20–22, 1986.

Weber U, Kern W, et al. Experimental cartenoid retinopathy. I. Functional and morphological alterations of the rabbit retina after 11 months dietary carotenoid application. Graefes Arch Clin Exp Ophthalmol 225: 198–205, 1987.

Herbal or supplement name: Chamomile (Matricariae

chamomilla).

Primary use

Chamomile is used to treat inflammation of the eye as well as insomnia, indigestion, migraine headaches, bronchitis, fevers, colds, inflammation and burns. The indications for the eye ­include eye irritation, styes, epiphora and inflammation.