Acetazolamide 
Acetylcholine
Acyclovir 
Adalimumab 
Amikacin 
Amphotericin B 
Ampicillin 
Apraclonidine
Atropine 
Azathioprine 
Azelastine 
Betaxolol 
Biologicals
Brimonidine 
Brinzolamide 
Bupivacaine
Capsofungin 
Cefazolin
Cidofovir 
Ciprofloxacin
Clotrimazole
Corticosteroids 
Cyclopentolate
Cyclosporine A 
Cyclophosphamide Daclizumab 
Dorzolamide
EDTA
Epinephrine 
Etanercept
Erythromycin 
Famciclovir 
Foscarnet
Fluconazole 
Fluorescein Sodium 
Fluorometholone 
5-Fluorouracil
Flurbiprofen   
Ganciclovir
Gatifloxacin 
Gentamicin
Glycerin 
Homatropine
Hydroxypropyl
Idoxurudine
Indocyanine Green 
Infliximab 
Interferon alpha
Itraconazole
Ketoconazole 
Ketorolac
Latanoprost 
Leflunomide 
Lidocaine 
Loteprednol
Mannitol 
Methotrexate 
Methylene Blue 
Mitomycin
Moxifloxacin
Mycophenolate Mofetil
Naphazoline
Natamycin 
Nedocromil Sodium 
Neomycin Sulfate 
Ofloxacin 
Olopatadine
Penciclovir
Pegaptanib
Pilocarpine
Timolol
Valacyclovir
Valganciclovir
Vidarabine
Voriconazole

 

 

 

 

 


Other Cholinergic Agents

Acetylcholine

It is used only for intraocular (intracameral route) administration. It produces complete miosis during ocular surgery and Used in cataract surgery, penetrating keratoplasty, peripheral Iridectomy and other anterior segment surgery.

It is available as powder and fresh ophthalmic solution (1:100 acetyl choline chloride). Usually 0.5 - 2 ml of this solution is required to produce good miosis. Solution need not be washed as it has a short duration 10-20 mins.

Carbachol

  1. It is a synthetic derivative of choline.
  2. It is dual action parasympathomimetic which produces direct motor end plates stimulation and at pre synaptic receptors to release acetylcholine. They are longer acting than pilocarpine. Thus greater stabilizing effect on diurnal pressure and myopia fluctuations.
  3. Comes in 0.75% to 3% concentration administered 3 to 4 times a day.
  4. Can be used in patients who are allergic to pilocarpine.

Methacholine

  1. It is also a synthetic derivative rarely used because it is unstable.
  2. It was used in 2% to 10% concentration.

Aceclidine

  1. A synthetic agent directly inhibits cholinesterase.
  2. Acts directly on the muscarinic end plates.
  3. It is weaker than pilocarpine and induces less miosis and accommodation than pilocarpine.

Miotics are contraindicated or avoided in:

Eyes with ocular inflammation.

Patients who are younger than 40.

Patients with central corneal opacities.

Moderate to severe myopia.

Presence of peripheral retinal degenerations.

Eyes with extensive synechial angle closure.

Malignant glaucoma.

Angle recession glaucoma (miotics causes a paradoxical IOP raise by decreasing uveoscleral outflow).

Acute pressure elevation in which the angle closure due to forward displacement of iris lens diaphragm.