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Excerpt:
Palmitoylethanolamide (PEA) in Glaucoma: A Review of Clinical EvidenceGlaucoma is an eye disease marked by optic nerve damage, often linked to high intraocular pressure (IOP). Standard glaucoma treatments focus on lowering IOP, but researchers are exploring neuroprotective supplements as add-ons. One promising compound is palmitoylethanolamide (PEA), a naturally occurring fatty acid amide with anti-inflammatory and neuroprotective effects (). PEA is found in foods (egg, soy, peanuts) and made in our bodies; it interacts with the endocannabinoid system and PPAR-α receptors to calm nerve inflammation. In Italy and parts of Europe, PEA is even sold as a medical food (e.g. “PeaPure,” Normast) for eye health (). Importantly, a recent analysis found that PEA treatment significantly lowers IOP in glaucoma and ocular hypertension patients (). In practice, PEA is usually given orally (often 600 mg per day in divided doses) alongside regular eye drops. This article reviews human trials of PEA in glaucoma, focusing on IOP reduction, nerve protection, dosing, and safety.PEA and Intraocular PressureSeveral clinical trials have tested whether oral PEA can help lower IOP in glaucoma or ocular hypertension. In these studies, patients usually continued their usual eye drops and added PEA tablets. A key finding is that PEA tends to produce a modest but statistically significant drop in IOP compared to control. For example, one randomized crossover trial added PEA (300 mg twice daily) to glaucoma therapy (timolol drops) in patients with open-angle glaucoma or ocular hypertension (). After two months on PEA, mean IOP fell by about 3.5 mmHg (15%) from baseline, versus only ~0.3 mmHg with placebo (). No changes in vision or side effects were seen. In practical terms, that 3.5 mmHg drop can be meaningful toward preventing nerve damage. Another well-designed study looked at ocular hypertensive patients (IOP above normal but no optic nerve damage) in a placebo-controlled crossover design (). Participants took 300 mg PEA twice a day for 3 months (with a 2-month washout then switch). The PEA period showed significantly lower IOP (around 22.2 mmHg) compared to placebo (23.0 mmHg) () – a reduction of about 0.8 mmHg. More strikingly, vascular function (flow-mediated dilation of the brachial artery) improved significantly on PEA and stayed better even after stopping PEA (). This suggests PEA not only lowers eye pressure slightly, but also boosts blood vessel health, which may benefit glaucoma.A meta-analysis of these trials confirms PEA’s pressure effect. Daily PEA intake (typically 600 mg total) was associated with about a 1.3 mmHg greater IOP reduction than placebo on average (). In plain terms, patients on PEA consistently saw small, statistically significant drops in IOP beyond what standard drops achieved () (). Even if 1–3 mmHg sounds minor, every bit helps protect glaucoma nerves. For example, one review concluded: “PEA showed significant efficacy in reducing IOP in patients…encouraging its clinical use in glaucoma” ().Some trials focused on specific situations. After laser iridotomy (a YAG laser opening in the iris, which can cause a temporary pressure spike), patients were pretreated with PEA or placebo for 2 weeks (2 tablets/day). The PEA group did not experience the usual IOP jump seen in the placebo group (). In other words, PEA “counteracted” the post-laser pressure rise, likely by reducing inflammation in the eye ().In summary, PEA taken orally (usually 300 mg twice daily, or 600 mg total) for weeks to months
