Cholinergics for Glaucoma

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Cholinergics for Glaucoma


Generic NameBrand Name
carbacholIsopto, Miostat Ophthalmic Liquid
pilocarpine Pilopine

Most of these medicines are given in eyedrop form. Pilocarpine can be given as a gel form (Pilopine).

Cholinergic medicine eyedrops have green bottle caps. If you need to use more than one type of eyedrop, you may need to take each medicine in a certain order. You can use the colour of the bottle cap to help you remember when to use each type of eyedrop.

If you are using more than one type of eyedrop, wait 5 minutes between the different eyedrop medicines.

How It Works

These medicines reduce pressure in the eyes by increasing the drainage of fluid (aqueous humor) out of the eye through the trabecular meshwork.

Why It Is Used

Cholinergics can be used to treat open-angle glaucoma. Pilocarpine is the cholinergic that is most often used to treat glaucoma.

Like beta-blockers, cholinergics can be used alone or combined with other glaucoma medicines. A combination of medicines can help control how much fluid is produced in the eye and increase the amount of fluid that drains out of the eye.

Cholinergic medicines may be used during an episode of closed-angle glaucoma after the pressure inside the eye has been reduced.

Cholinergics are one of the oldest types of medicines used to treat glaucoma. But because they can cause significant side effects, and there are other effective medicines to treat glaucoma, cholinergic medicines are not used as frequently as in the past.

How Well It Works

These medicines have the strongest effect on the pressure in the eye during the 2 to 4 hours after medicine is applied. The medicine continues to work for 4 to 8 hours after use.

Side Effects

Side effects of cholinergics include:

  • Stinging, burning when eyedrops are used.
  • Blurred vision, problems with night vision, and problems with focusing at a far distance.
  • Brow ache (headache above the eye in the eyebrow area). This usually gets better after 1 to 2 weeks and is not a reason to stop the medicine.
  • Diarrhea, nausea, or vomiting.
  • Clouding of the lens (cataract) or pulling away of the inside lining of the eye (retinal detachment).
  • Increased salivation, tearing in the eyes, or sweating.

Report any change in your vision, including dimmer sight, flashing lights, or floating spots. Also tell your doctor right away if you have any loss of eyesight.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Pilocarpine has few side effects on the rest of the body. But it is not used as often as other medicines, because it causes blurred vision and works for only a short time. Many people find it uncomfortable to apply pilocarpine because of the stinging feeling that the medicine causes.

Compared to pilocarpine eyedrops, pilocarpine gel (Pilopine) can be applied once each day. But the gel is more expensive than the eyedrops. For some people it may be harder to use than eyedrops.

Cholinergics are more powerful when combined with a carbonic anhydrase inhibitor (such as dorzolamide [Trusopt] or brinzolamide [Azopt]). Newer combinations that are also an additive include pilocarpine and latanoprost (Xalatan). But when a combination of medicines is used, the person may need to put in different eyedrops as many as 8 times a day.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.


By Healthwise Staff
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Primary Medical Reviewer Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer Christopher J. Rudnisky, MD, MPH, FRCSC - Ophthalmology
Last Revised August 2, 2010

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