Pharmacology

Miotic Agents

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  • Heroin reduces the cortical inhibition of the Edinger-westphal nucleus
  • Carbachol increases acetylcholine release
  • Physostigmine inhibits acetylcholinesterases
  • Alpha blockers paralyse the dilator muscle
  • Pilocarpine stimulates acetylcholine muscarinic receptors
    • Causes ciliary muscle contraction, pulling on the scleral spur to open the TM and increase trabecular outflow.

    • Ocular side effects: fluctuating myopia, constricted VF due to miosis, reduced night vision, increased risk of corneal graft rejection

    • Contraindicated in inflammatory glaucoma or aqueous misdirection
  • Guanethidine (inhibits noradrenaline release from nerve terminals)

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Sympathetic Neurotransmission