Side Effects and Ways to Avoid Them

Pressure Lowering Medications

“…The miotic effect of pilocarpine can cause visual incapacitation and is unwelcome in patients with nuclear sclerotic and posterior sub-capsular cataract. Furthermore, long-term use of pilocarpine may hasten cataract development (Zimmerman and Wheeler, 1982). Paradoxically, although pilocarpine is used to break the iridotrabecular contact in PAC cases, there are reported cases of pupillary block induced by pilocarpine, which usually occurs in patients with narrow angles who have advancing cataract (Van Burskirk, 1982;Ritch, 1996).…”

“…Headache, nausea, vomiting, diaphoresis, and weakness are possible systemic side effects and can be easily confused with symptoms of acute PAC (Zimmerman and Wheeler, 1982). Other systemic side effects include increased salivation and lacrimation, diarrhoea, bronchiolar spasm, pulmonary oedema, systemic hypotension, and bradycardia (Zimmerman and Wheeler, 1982).…”

Medications Used to Treat Glaucoma

“…385 We usually start patients on 1 or 2% pilocarpine and increase to the 4% concentration if necessary after several weeks. This allows them to tolerate what can be a severe brow ache with the higher strength.…”

“…The indirect acting miotics and higher concentrations of pilocarpine may cause iris pigment cysts 385 and pseudopemphigoid. 389,390 Highly myopic patients may suffer retinal tears or detachments with the stronger concentrations of miotic agents.…”

“…385 Because cholinesterase activity is suppressed by the indirect acting miotics, succinylcholine should not be administered to patients undergoing anesthesia until at least 6 weeks after ceasing these glaucoma drugs. 393 Today, miotic agents for glaucoma are used more as the exception in Western countries rather than as the rule.…”