Miotic adverse effects

The antimuscarinic properties result in what are usually the most troublesome adverse effects dry mouth, blurred vision, constipation, and (mainly in older males) urinary hesitancy and retention. Pupil size, and hence risk of glaucoma, is determined by a balance between anticholinergic (mydriatic) and sympathomimetic (miotic) effects. 

Of the commonly used therapeutic drugs, the greatest risks are encountered when clinicians prescribe topical steroids (for extended periods), systemic steroids, P blockers, miotic antiglaucoma agents, and oral carbonic anhydrase inhibitors (CAIs). Optometrists should be aware of the adverse effects that attend the use of these drugs and should warn patients accordingly. Disclosures should be documented in the patient record. 

Legal claims arising from glaucoma therapy may be divided into three categories adverse effects of beta-blockers, retinal detachments after initiation of miotic therapy, and complications resulting from use of CAIs. 

Carbachol is a potent direct-acting miotic agent its duration of action is longer than that of pilocarpine (8 to 10 hours) because of resistance to hydrolysis by cholinesterases. This drug also may act as a weak inhibitor of cholinesterase. Patients with an inadequate response to or intolerance of pilocarpine as a result of ocular hritation or allergy frequently do well on carbachol. The ocular and systemic adverse effects of carbachol are similar to butmore frequent, constant, and severe than those of pilocarpine. " ... 

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