To anyone out there... Can pilocarpine induce cataracts or glaucoma?

Pilocarpine does not cause cataracts but, due to the pupil constriction it causes, can temporarily reduce the vision of patients who already have cataracts.

Pilocarpine was(is) used to treat open angle glaucoma. The miosis created may reduce the tendency for angle-closure glaucoma but could occasionally induce angle-closure as it wears off. If your anterior chamber angles are wide open, this should not be a concern.

If you are using pilocarpine to reduce symptoms of GASH, a 1/8% concentration is effective but you may have to have it made by a compounding pharmacy. Certainly you should use the weakest solution available (0.25% is available without compounding). Chronic use of stronger solutions may induce retinal detachments in patients predisposed to retinal tears.

And what if a doctor once told me that my retina is like kind of wrinkled on the edges...(he said it was perfectly normal for someone whos had -5 myopia most of her life), would that make me predisposed to retinal detachment?

It might. If you are concerned, have a thorough retinal exam.

The correlation of pilocarpine use with RD is not so much for patients with occasional use of low concentrations but greater for patients taking stronger doses chronically. Pilocarpine used to be THE drug for glaucoma. Typically the patient would be started on 0.5%, three or four times a day with gradually increasing doses, up to 4% and 6%. These patients would have pinpoint pupils. The more the constriction, the more the potential for RD. Again, you are not constricting your pupils as much or for as long as those who used the drug for glaucoma.

i was told that the lowest concentration now commercially available is 0.5%. hope it doesn't keep going up.

Andrew,

See http://visionsurgeryrehab.evecommunity.com/eve/forums/a...116028594#4116028594 for a thread where koneall talks about how he dilutes pilocarpine to make it work for him. That might be a possibility for others who are sensitive to the higher concentrations.

I can't use either pilo or alphagan, but I also have problems with many other drops. I have found, however, that a few drops of Unisol 4 unpreserved saline instilled a minute or so before adding the other drops make them disperse better over my dry eyes and reduces any stinging or burning sensation. Without, everything feels like acid.

Thanks, Barbara.

quote:

Using a needle and syringe, I add 2ml of 1% Pilocarpine to a 14ml bottle of artificial tears. If my math is correct, that gives me a 1/8% dilution of Pilocarpine.

Unfortunately needles/syringes are hard to come by without a prescription. I imagine a compounding pharmacy could get pricey.

I've just been diluting it in the eye with some saline.

i managed to obtain solder syringes(new) on ebay. they pretty much look just like medical syringes only the tip is slightly wider and they are not beveled/sharp. they fit into an eyedrop vial with a slight push.

i dilute the pilo with cl solution, which has a disinfecting agent. that's good enough for me. i'd almost rather stab myself in the eye with one of my syringes than accept ANYTHING from an ophthalmologist these days. the last "ophthalmologist" i saw described my severe GASH as "subjective visual complaints." he had formerly done RS.

my hmo requires me to see an ophthalmologist to obtain a "compounded Rx." i will not take a Rx from him/her. i don't know if i even trust him/her to examine my eyes/retinas. maybe i should teach myself ophthalmology.

Subjective visual complaints, eh. That's why the FDA is now investigating depression after bad Lasik results.

Now that you've found them, do the syringes work for you?

yes they seem to be working - thanks.

i've created 1/8 % pilocarpine which still seems to cause transient blurred vision like the higher dosages. i may go even lower.

i'm thinking that, at such low dosages, i can just use it as needed? 3 or more times per day?

thanks.

i've found my dosage at 1/16%!

That's great! Hope that between the drops and the RGPs you are seeing clearly again--and that life is returning to some semblance of normal!

for diluting the pilocarpine if you are not using 1% it helps to think of it in terms of being part 1%. for example if you are using .5%, two mL(or drops) of that are equivalent to one ml of 1% and one blank ml. 4 of .25% equal 1 of 1% and 3 blanks, etc.

i created 1/14% last night by combining 2 ml of .5%(= 1 ml 1%, 1 ml blank) with 12 ml of contact lens solution.

just a general FYI.