Pilocarpine 2% Eye Drops

How it works

It directly stimulates muscarinic receptors to contract the ciliary muscle and iris sphincter, which opens the trabecular meshwork to increase aqueous outflow and produces pupil constriction.

Prescribing in practice

• In acute angle-closure glaucoma it is used as part of urgent specialist treatment to break the attack, and prompt ophthalmology input is essential to preserve sight.
• Ciliary muscle spasm can cause brow ache, headache and a myopic shift, and the small pupil may impair vision especially in dim light or where there is lens opacity.
• It should be used with caution in conditions where pupillary constriction is undesirable, such as some forms of secondary glaucoma and acute iritis.

Monitoring

Intraocular pressure and pupillary response are monitored to confirm the desired effect, with close review during treatment of acute angle closure.

Counselling the patient

• Your vision may be dim, particularly in low light, and you may notice brow ache or headache when starting treatment.
• Avoid driving at night or until you know how the drops affect your vision.
• Use the drops regularly as prescribed and do not stop without advice, as this helps control eye pressure.

Evidence & guidelines

Pilocarpine is a long-established miotic for glaucoma and acute angle closure, with its role detailed in ophthalmology guidance and the SPC.