effects side ocular induced-Drug • 7 t Pa r

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Merritt JC, et al. Topical 9-tetrahydrocannabinol in hypertensive glaucomas. J Pharm Pharmacol 33: 40, 1981.

Poster DS, et al. 9-Tetrahydrocannabinol in clinical oncology. JAMA 245: 2047, 1981.

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Generic names: 1. Lysergic acid diethylamide (LSD), lysergide; 2. mescaline; 3. psilocybin.

Proprietary name: None.

Street names: 1. Acid, barrels, big d, blotter acid, blue acid, brown dots, California sunshine, crackers, cubes, cupcakes, grape parfait, green domes, Hawaiian sunshine, Lucy in the sky with diamonds, micro dots, purple barrels, purple haze, purple ozolone, sunshine, the animal, the beast, the chief, the hawk, the ticket, trips, twenty-five, yellow dimples, windowpane;

2. buttons, cactus, mesc, peyote, the bad seed, topi; 3. magic mushroom, shrooms.

Primary use

Illicit psychedelic and psychotomimetic agents that may be both natural and synthetic products.

Ocular side effects

Systemic administration

Certain

1.Visual hallucinations

a.Image distortion

b.Color intensification

c.Geometric figure

d.False perception of movement

e.Afterimages

2.Spontaneous recurrence of abnormal visual perception following discontinuation of the drug (LSD)

a.Transitory

b.Long term

c.Permanent

3.Palinopsia – visual perversion of recently seen objects (LSD)

a.Acute

b.Permanent

4.Problems with color vision

a.Color vision defect

b.Heightened color perception

5.Pupils

a.Mydriasis

b.Anisocoria

c.Decreased or absent reaction to light

6.Decreased accommodation

7.Decreased dark adaptation

8.Decreased vision

9.Abnormal ERG, VEP and depressed critical flicker fusion

10.Photophobia

Topical ocular application – liquid LSD

Conditional/Unclassified

1. Cornea

a.Melting

b.Scarring

c.Severe pannus

2. Conjunctiva - scarring

Ocular teratogenic effects

Possible

1.Cataract

2.Iris coloboma

3.Ocular dysplasia

4.Microphthalmos

5.Corneal opacities

6.Persistent hyperplastic primary vitreous

7.Retinal dysplasia

8.Optic disc hypoplasia

9.Optic nerve coloboma

10. Anophthalmia

Clinical significance

Ocular side effects due to these drugs are very common. Some claim true visual hallucinations seldom occur with these drugs, but rather a complicated visual experience results from a drug-induced perceptual disturbance. Perception changes include alterations in colors and shapes. Halpern and Pope (2003) reviewed the literature on ‘hallucinogen persisting perception disorder’, also known as flashbacks. They are uncommon, but can persist for months or even many years. Some have persisted for 20 years plus. Lysergide (LSD) is 100 times more potent than psilocybin, which in turn is 4000 times more potent than mescaline. The above visual side effects are therefore due to LSD and then to a lesser degree to the other agents. A large number of cases of sun gazing-induced macular damage has been reported in persons using these agents. Abraham (1982) first reported irreversible impairment of color discrimination. Kawasaki and Purvin (1996) reported three patients who had persistent palinopsia after LSD ingestion. These prolonged after-images lasted 3+ years after being off the drug.

A case of liquid LSD splashed into one eye of a 20-year-old has been reported to the National Registry. The cornea had significant melt with a resultant marked pannus. A conjunctival flap was necessary to save the globe. The eye was permanently disabled.

References and Further Reading

Abraham HD. A chronic impairment of colour vision in users of LSD. Br J Psychiatry 140: 518, 1982.

Abraham HD. Visual phenomenology of the LSD flashback. Arch Gen Psychiatry 40: 884, 1983.

Abraham HD, Duffy FH. EEG coherence in post-LSD visual hallucinations. Psychiatry Res 107: 151–163, 2001.