Case File-2

A 61-year-old man is noticed to have increased intraocular pressure on a routine eye examination. The visual acuity is normal in both eyes. The dilated eye examination reveals no evidence of optic nerve damage. Visual field testing shows mild loss of peripheral vision. He is diagnosed with primary open-angle glaucoma and is started on pilocarpine ophthalmic drops.

Questions 1. What is the action of pilocarpine on

the muscles of the iris and cilia?2. What receptor mediates this action?3. Is pilocarpine the appropriate first-

line drug for the treatment of primary open-angle glaucoma?

Summary A 61-year old man with open-angle

glaucoma is prescribed pilocarpine ophthalmic drops

Action of pilocarpine on muscles of the iris and cilia

Constriction of the muscles

Receptor that mediates this action

Muscarinic cholinoreceptor

First line drugs to treat primary open-angle glaucoma

Prostaglandin analogs