• A patient with unilateral angle-recession glaucoma had an ipsilateral increased intraocular pressure (IOP) with miotics despite open angles, and decreased IOP with cycloplegics. The following mechanism is proposed to explain these findings: Pilocarpine hydrochloride has been demonstrated experimentally to increase trabecular outflow and decrease uveoscleral outflow. In this eye with a severely compromised and unresponsive trabecular outflow, miotics served to impair uveoscleral outflow and cause a net rise in IOP. Similarly, an increase in uveoscleral outflow with cycloplegics served to decrease IOP. The use of atropine sulfate in these rare cases may be of therapeutic value in lieu of systemic or surgical therapy.
Bleiman BS, Schwartz AL. Paradoxical Intraocular Pressure Response to PilocarpineA Proposed Mechanism and Treatment. Arch Ophthalmol. 1979;97(7):1305-1306. doi:10.1001/archopht.1979.01020020047010