Pilocarpine is a miotic—one of the oldest medications in ophthalmology for treating glaucoma.
How does Pilocarpine work?
The medication causes the circular muscle in the eye to contract, thereby constricting the pupil (miosis) and opening the drainage angle. This mechanism stretches the drainage system (trabecular meshwork) and improves fluid outflow. It is particularly effective in preparation for laser treatments for closed-angle (LPI) and in preventing angle-closure attacks.
Why has its use declined?
Today, pilocarpine is not used as a routine, daily treatment for most patients due to the need for frequent instillation (up to 4 times a day) and its side effects: dark and blurred vision (due to a very small pupil), brow ache and headaches, and an increased risk of retinal detachment.