Anterior segment complications of a nutritional supplement

A patient who had been taking an oral L-arginine-based body-building supplement developed bilateral diffuse subconjunctival hemorrhages, circumcorneal dilated vessels, and peripheral corneal infiltrates after bilateral laser in situ keratomileusis. There is limited information regarding the efficacy, safety, and constituents of nutritional supplements because the U.S. Food and Drug Administration regulates them differently than prescription medications, and they do not require approval prior to marketing. These products may result in adverse effects as evidenced by the subconjunctival hemorrhages (an exaggerated vasodilator and antithrombotic effect of nitric oxide formed from arginine) and peripheral corneal infiltrates in this case. The case highlights the importance of eliciting a history of nutritional supplement and/or herbal medication use, especially in patients scheduled to have surgery.