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Paradoxical Intraocular Pressure Response to Pilocarpine: A Proposed Mechanism and Treatment

Paradoxical Intraocular Pressure Response to Pilocarpine: A Proposed Mechanism and Treatment Abstract • A patient with unilateral angle-recession glaucoma had an ipsilateral increased intraocular pressure (IOP) with miotics despite open angles, and decreased IOP with cycloplegics. The following mechanism is proposed to explain these findings: Pilocarpine hydrochloride has been demonstrated experimentally to increase trabecular outflow and decrease uveoscleral outflow. In this eye with a severely compromised and unresponsive trabecular outflow, miotics served to impair uveoscleral outflow and cause a net rise in IOP. Similarly, an increase in uveoscleral outflow with cycloplegics served to decrease IOP. The use of atropine sulfate in these rare cases may be of therapeutic value in lieu of systemic or surgical therapy. References 1. Alafano JE, Alafano PA: Glaucoma and the superior vena cava obstruction syndrome . Am J Ophthalmol 42:685-695, 1956. 2. Flocks M, Zweng HC: Studies on the mode of action of pilocarpine on aqueous outflow . Am J Ophthalmol 44:380-387, 1957. 3. Kolker AE, Hetherington J: Becker and Shaffer's Diagnosis and Therapy of the Glaucomas . St Louis, CV Mosby Co, 1976, p 197. 4. Havener WH: Ocular Pharmacology . St Louis, CV Mosby Co, 1974, p 691. 5. Richardson K: Pharmacology , in Duane TD (ed): Clinical Ophthalmology . New York, Harper and Row, 1976, vol 3, p 2. 6. Bill A, Phillips C: Uveoscleral drainage of aqueous humor in human eyes . Exp Eye Res 12:275-281, 1971.Crossref 7. Bill A: The aqueous humor drainage mechanism in the cynomolgus monkey with evidence for unconventional routes . Invest Ophthalmol 4:911-919, 1965. 8. Inomata H, Bill A: Exit sites of uveoscleral flow of aqueous humor in cynomolgus monkey eyes . Exp Eye Res 25:113-118, 1977.Crossref 9. Bill A, Walinder P: The effects of pilocarpine on the dynamics of aqueous humor in a primate . Invest Ophthalmol 5:170-175, 1966. 10. Bill A: Effects of atropine and pilocarpine on aqueous humor dynamics in cynomolgus monkeys . Exp Eye Res 6:120-125, 1967.Crossref 11. Bill A: Conventional and uveoscleral drainage of aqueous humor in the cynomolgus monkey at normal and high intraocular pressure . Exp Eye Res 5:45-54, 1966.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

Paradoxical Intraocular Pressure Response to Pilocarpine: A Proposed Mechanism and Treatment

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Publisher
American Medical Association
Copyright
Copyright © 1979 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.1979.01020020047010
Publisher site
See Article on Publisher Site

Abstract

Abstract • A patient with unilateral angle-recession glaucoma had an ipsilateral increased intraocular pressure (IOP) with miotics despite open angles, and decreased IOP with cycloplegics. The following mechanism is proposed to explain these findings: Pilocarpine hydrochloride has been demonstrated experimentally to increase trabecular outflow and decrease uveoscleral outflow. In this eye with a severely compromised and unresponsive trabecular outflow, miotics served to impair uveoscleral outflow and cause a net rise in IOP. Similarly, an increase in uveoscleral outflow with cycloplegics served to decrease IOP. The use of atropine sulfate in these rare cases may be of therapeutic value in lieu of systemic or surgical therapy. References 1. Alafano JE, Alafano PA: Glaucoma and the superior vena cava obstruction syndrome . Am J Ophthalmol 42:685-695, 1956. 2. Flocks M, Zweng HC: Studies on the mode of action of pilocarpine on aqueous outflow . Am J Ophthalmol 44:380-387, 1957. 3. Kolker AE, Hetherington J: Becker and Shaffer's Diagnosis and Therapy of the Glaucomas . St Louis, CV Mosby Co, 1976, p 197. 4. Havener WH: Ocular Pharmacology . St Louis, CV Mosby Co, 1974, p 691. 5. Richardson K: Pharmacology , in Duane TD (ed): Clinical Ophthalmology . New York, Harper and Row, 1976, vol 3, p 2. 6. Bill A, Phillips C: Uveoscleral drainage of aqueous humor in human eyes . Exp Eye Res 12:275-281, 1971.Crossref 7. Bill A: The aqueous humor drainage mechanism in the cynomolgus monkey with evidence for unconventional routes . Invest Ophthalmol 4:911-919, 1965. 8. Inomata H, Bill A: Exit sites of uveoscleral flow of aqueous humor in cynomolgus monkey eyes . Exp Eye Res 25:113-118, 1977.Crossref 9. Bill A, Walinder P: The effects of pilocarpine on the dynamics of aqueous humor in a primate . Invest Ophthalmol 5:170-175, 1966. 10. Bill A: Effects of atropine and pilocarpine on aqueous humor dynamics in cynomolgus monkeys . Exp Eye Res 6:120-125, 1967.Crossref 11. Bill A: Conventional and uveoscleral drainage of aqueous humor in the cynomolgus monkey at normal and high intraocular pressure . Exp Eye Res 5:45-54, 1966.Crossref

Journal

Archives of Ophthalmology – American Medical Association

Published: Jul 1, 1979

References

  • Glaucoma and the superior vena cava obstruction syndrome
    Alafano JE, Alafano PA
  • Studies on the mode of action of pilocarpine on aqueous outflow
    Flocks M, Zweng HC
  • Becker and Shaffer's Diagnosis and Therapy of the Glaucomas
    Kolker AE, Hetherington J
  • Ocular Pharmacology
    Havener WH
  • Clinical Ophthalmology
    Richardson K
  • Uveoscleral drainage of aqueous humor in human eyes
    Bill A, Phillips C
  • The aqueous humor drainage mechanism in the cynomolgus monkey with evidence for unconventional routes
    Bill A
  • Exit sites of uveoscleral flow of aqueous humor in cynomolgus monkey eyes
    Inomata H, Bill A
  • The effects of pilocarpine on the dynamics of aqueous humor in a primate
    Bill A, Walinder P
  • Effects of atropine and pilocarpine on aqueous humor dynamics in cynomolgus monkeys
    Bill A
  • Conventional and uveoscleral drainage of aqueous humor in the cynomolgus monkey at normal and high intraocular pressure
    Bill A