gms | German Medical Science

Photosensitisation effects are known for furanocumarines occurring in different herbal families. The presented case report describes an acquired solar retinopathy with intake of Hypericum perforatum essence.

A 39-year-old patient was presented to our clinic with sudden visual degradation since 3 days left more than right. Visual acuity was 0.6 for the right and 0,3p for the left eye. Clinically a white and yellowish lesion of the fovea centralis appeared with positive Watzke test. Fluorescein angiography showed a regular result. With focused medical history the patient reported of the intake of Saint-Johns-wort extract because of a depression. Additionally the patient indicated to have looked into the sun 3 days ago through a fly screen for a long time.

The therapeutic insertion of Hypericum perforatum can be traced back to the early antiquity. As herbal medicine Saint-John-wort is widely used because of postulated rare side effects and is as prescription free drug available in Germany in about 50 preparations on the market. The Phloroglucinderivate Hyperforin (Hypericin) is discussed as the active substance that blocks neural intake of dopamine, GABA and glutamate. As well as induction of the Cytochrom P-450 complex photosensitisation effects are to be considered.

Basic knowledge of side effects of often in clinical practice used medicine is essential. With prescription free medicine a special responsibility comes up druggist and patient. However, this can be limited especially with psychologically unstable patients. Photosensitisation effect of Hypericum perforatum can lead to a solar retinopathy also in winter months and without solar eclipse.