Paper I
2018 July (Supplementary) (2010 Scheme) · 40 marks · 120 min

Question

Rationale for use of pilocarpine in glaucoma

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Answer

Pilocarpine is a direct-acting muscarinic agonist. Topically applied, it stimulates M3 receptors in the ciliary muscle and iris sphincter, causing contraction of the ciliary muscle (which pulls open the trabecular meshwork, increasing aqueous humour outflow) and miosis (which pulls the iris away from the angle in angle-closure glaucoma, relieving obstruction to aqueous outflow). Both effects reduce intraocular pressure, making it useful in both open-angle and acute angle-closure glaucoma (the latter as an emergency adjunct).

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