The Endocannabinoid System May Offer a Two-Pronged Approach to Glaucoma: Pressure Reduction and Nerve Protection

The endocannabinoid system (including ligands, receptors, and enzymes) is present throughout the visual system from eye to occipital lobe. Cannabinoid receptor activation both lowers intraocular pressure and provides neuroprotection by reducing excitotoxicity and modulating vascular tone — potentially addressing both the pressure and neurodegeneration aspects of glaucoma.

Literature review searching PubMed, ScienceDirect, and Google Scholar for studies on endocannabinoids and glaucoma, encompassing animal studies, in vitro models, and limited human data. Focused on IOP-lowering and neuroprotective mechanisms.

Current glaucoma treatment only targets intraocular pressure, yet many patients still lose vision. There are no approved neuroprotective treatments for glaucoma. If cannabinoid-based therapies can both lower pressure and protect nerve cells, they could revolutionize glaucoma management.

The recognition that intraocular pressure alone doesn't fully explain glaucoma progression has driven the search for neuroprotective agents. The endocannabinoid system's dual action — addressing both pressure and neurodegeneration — makes it one of the most promising therapeutic targets in glaucoma research.

Mostly animal and in vitro evidence — human clinical data is scarce. The well-known IOP-lowering effect of cannabis is short-lived and impractical for chronic treatment. No cannabinoid-based glaucoma drug is currently available. Long-term safety of ocular cannabinoid delivery unknown.