Ophthalmology/Miotic / acute angle-closure

Pilocarpine & acute angle-closure

also: pilocarpine · miotic · acute angle-closure glaucoma · AACG

Overview

Pilocarpine constricts the pupil to open the drainage angle — central to acute angle-closure glaucoma, the ophthalmic emergency. The emergency combination + definitive laser iridotomy are high-yield.

Mechanism

Muscarinic (M3) agonist → contracts the ciliary muscle and iris sphincter → pulls the peripheral iris away from the trabecular meshwork → opens the angle and increases trabecular outflow.

Indications

Acute angle-closure glaucoma (emergency)
Some chronic open-angle glaucoma

The agents

PilocarpineM3 agonist (miotic)

Constricts pupil; brow ache, blurred vision, miosis.

Adverse effects

Miosis, brow ache, blurred/dim visionclassic

Headache, ocular discomfortcommon

Cautions & contraindications

Conditions where pupil constriction is harmful (some uveitis)all

Interactions

Monitoring & kinetics

IOP; AACG is an emergency — same-day ophthalmology

Topical. AACG EMERGENCY combination = pilocarpine + topical β-blocker (timolol) + α₂-agonist (apraclonidine) + IV/oral acetazolamide ± topical steroid; lie flat; DEFINITIVE treatment = laser peripheral iridotomy (both eyes).

Source: NICE CKS — Glaucoma (acute) · BNF — Miotics