gms | German Medical Science

102. Jahrestagung der DOG

Deutsche Ophthalmologische Gesellschaft e. V.

23. bis 26.09.2004, Berlin

Solar retinopathy as visual threatening side effect with intake of Hypericum perforatum

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  • corresponding author R. Lämmer - Augenklinik mit Poliklinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen
  • C.Y. Mardin - Augenklinik mit Poliklinik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen

Evidenzbasierte Medizin - Anspruch und Wirklichkeit. 102. Jahrestagung der Deutschen Ophthalmologischen Gesellschaft. Berlin, 23.-26.09.2004. Düsseldorf, Köln: German Medical Science; 2004. Doc04dogP 186

The electronic version of this article is the complete one and can be found online at:

Published: September 22, 2004

© 2004 Lämmer et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.




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.