Acetylcholine 1% Intraocular Solution

How it works

As a direct muscarinic agonist it stimulates the iris sphincter muscle to contract, constricting the pupil promptly when applied directly within the eye.

Prescribing in practice

• It is for intraocular surgical use only and must be prepared and used immediately, as the solution is unstable in solution once reconstituted.
• Systemic muscarinic effects such as bradycardia, hypotension, bronchospasm and increased secretions can occur and should be anticipated peri-operatively.
• Caution applies in patients with asthma, significant bradyarrhythmia, peptic ulcer disease or other conditions sensitive to cholinergic stimulation.

Monitoring

Monitor heart rate, blood pressure and respiratory status during and immediately after intraocular use given the potential for systemic cholinergic effects.

Counselling the patient

• This medicine is used by the surgeon inside the eye during your operation to make the pupil smaller.
• It acts only briefly during surgery.
• Any feeling of flushing, a slow pulse or wheeze during the procedure will be managed by the theatre team.

Evidence & guidelines

Intraocular acetylcholine is a well-established agent for producing rapid miosis during anterior segment surgery, used per its SPC.