Fluid inside your eye needs to be maintained at an optimal pressure level. Increase in inner eye fluid pressure is not good for your eye’s health. A few eye conditions may develop when eye pressure level tends to increase; one such optic condition is closed angle glaucoma. Of the various types of glaucoma, closed angle type is not very common. On the other hand, open angle glaucoma is a frequently encountered condition. Timely treatment is needed for treating closed angle glaucoma; delayed treatment or no treatment can soon impair your optic nerves. Can you use pilocarpine for treating closed angle glaucoma? You need to find out more on this before starting your treatment.

Your eye produces a fluid at the rear side of the iris. This fluid runs from all through the pupil and reaches the frontal chamber of eyeball. As the fluid traverses through your pupils, it passes through a network of channels. These channels are called trabecular mesh linked to veins of the white part of your eye (this white area is called sclera). Closed angle glaucoma is an eye condition wherein fluids do not drain out of your eyes. You may encounter closed angle glaucoma when there is damage or an injury in this mesh. As a result, eye fluid does not have a conduit to flow out, and its flow may remain hindered. This action causes an accumulation of fluids inside the eye; it is this build-up that causes an increase in inner eye pressure level.

Types and risk factors

Closed angle glaucoma can be of 2 distinctive types; primary and secondary types. The primary form of closed angle glaucoma occurs when iris gets pressed against the trabecular mesh; this is due to the very structure of your eye(s). Key reasons behind incidence of this primary form are – presence of thin iris, shorter eyeballs and / or a narrow angle in between cornea and iris. On the other hand, secondary form of closed angle glaucoma is witnessed when changes / injuries in eye forces your iris onto the mesh. Apart from an eye injury, the secondary form can occur when you experience internal swelling, autoimmune conditions such as tumors, living with increased blood sugar conditions like diabetes mellitus, etc. Moreover, people who have an advanced level of cataract or those who have a clouded lens may also tend to develop the secondary form of closed angle glaucoma.

This eye condition occurs very gradually and without many signs. The best way to diagnose an incidence of closed angle glaucoma is to opt for a periodic eye examination. The risk factors are more pronounced among those aged above 40 years, especially with women as well as those of south Asian descent. You are advised to remain watchful of key signs such as blurring of eyesight, reddening of eyes, painful eyes and sensing a bright halo around objects. Also, those with farsightedness are more vulnerable to this eye condition.

Treatment of closed angle glaucoma

There are various treatment options – mainly through the use of drugs. Drugs such as beta blockers help lower the quantum of fluids your eye makes; meds like acetazolamide also can decrease the level of inner eye fluid. So, if you are living with swelling or inflammation of eyes – your doctor may prescribe a few steroids. Of the many treatment options, prescription of pilocarpine helps open the angle between your cornea and iris.

In some cases, an eye surgery is performed to prevent pressure from building up inside your eyes. Of the many types of surgeries, 2 leading procedures to treat closed angle glaucoma are surgical iridectomy and peripheral iridectomy. The former is done by making a tiny aperture (a triangular one) in the iris. The latter is more common wherein a laser creates small holes to drain fluids in the iris. The peripheral approach is used for both chronic spells as well as acute episodes of closed angle glaucoma.

What is pilocarpine?

Pilocarpine is a widely used eye med, prescribed for treating glaucoma. This med is categorised under a genre of drugs called miotics. This drug helps flush extra fluid present inside your eye(s). You must remember that pilocarpine is not sold as an over the counter (OTC) eye drop. You may be able to buy it with a prescription from your eye specialist or an ophthalmologist. As this drug helps decrease inner eye pressure levels, it is administered as per instructions of the treating doctor. Depending on your eye condition, the range of use may vary. Some people with glaucoma may have to use it for upto three times each day. In some cases, it must be used only once per day. Those who use contact lenses must remove them before using this drug. It is a safe practice to wear them again only after 15 minutes from the time of each dose.

Prior to using pilocarpine it is important to clean your fingers. As an added safety measure, do not handle the dropper with unclean fingers; such a practice may contaminate this drug. If you are using other meds, you are advised to delay such doses for at least 10 minutes. Also, it is essential to administer these eye drops strictly per your treatment plan. Skipping several doses or bringing the doses to an abrupt stop can only result in a relapse of your eye condition.

What are the side effects of pilocarpine?

This eye drop med may cause a few adverse effects as well as some undesired reactions. You may witness side effects like a burning sensation, reddened eyes or discharge of fluids from eyes, severe episodes of migraines / headaches, becoming sensitive to light, pain on the brows, blurred eyesight, constricted pupils, etc. It is not a safe practice to use contact lenses as the active chemicals of pilocarpine can damage your lenses permanently; added care is needed by those wearing softer forms of contact lens. Hence, it is essential to wear such lens only after a time interval of 15 to 20 minutes after every dose. Also, never consume alcohol while you are using this eye medication.

If you are likely to undergo a dental procedure or a surgical intervention, your caregiving team (dental / surgical) must know of your treatment plans – including the doses of pilocarpine and the duration of the medication plan. It is a safe practice to discontinue application of these eye drops for at least 2 weeks during the run-up to your surgical intervention / dental procedure. As these eye drops may react adversely with anesthetic drugs, needful precautions are required to avoid any possible interactions. Prior to going for a surgery, inform your eye doctor of all the medications you are presently taking and the treatment plans currently pursued. Better still – make a list of all the drugs; as you are compiling this list, care to include over the counter (OTC) drugs, herbal aids, prescription meds, supplements of minerals, vitamins and / or proteins, dietary aids – if any, etc. It is unsafe to change your medication plans (after sharing the list) without the knowledge of your treating doctor.

If you are pregnant, your eye doctor must know of your medical condition. Evidence on safety of this eye drop on pregnant women is available only to a limited extent. Treating physicians also seldom prescribe this eye medication onto women who are pregnant – regardless of the stage of their pregnancy. In some remote instances this drug may have been administered onto pregnant women; in all such cases, physicians ensure that the benefits of using this med outstrip risks of side effects on pregnant women and their fetus. In essence, it is highly recommended to consult with your caregiver prior to using this eye drop.

On the other hand, if you are planning to become pregnant, talk to your eye doctor about the side effects of getting pregnant while using this drug. You may be advised to use a suitable birth control measure / contraceptive to acid any unplanned pregnancies. Likewise, those who are breastfeeding a new-born infant must understand the risks involved. As the drug is not considered safe for women who are breastfeeding (due to the potential entry of key chemicals of pilocarpine into breastmilk), talk to your caregiver prior to using this eye drop.

The aforesaid side effects and adverse reactions do not form a complete list of all possible risks of using pilocarpine. You may experience a few unknown side effects or unlisted reactions. If you are witnessing such unlisted side effects, call your physician on an emergency basis. Owing to blurring of eyesight and dulling of vision, you are not advised to perform adventurous / sporting actions like gliding, jumping, etc. It is equally unsafe to work on heavy machines, drive vehicles or in general, doing tasks that demand a high level of concentration or focus.

Above all, if you are experiencing any of the above adverse side effects, call 911 on an emergency basis. You can reach out to food and drug administration (FDA) which runs its own helpline to provide needful medical support to users witnessing adverse side effects from drugs it has cleared. On the other hand, pilocarpine users in Canada – upon witnessing severely adverse reactions – need to rush to a poison control center on an emergency basis or dial Health Canada for urgent medical help.

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