In the past, meiotics have been widely used for the treatment of chronic open-angle glaucoma. Pilocarpine is available in 1%, 2%, 3% or 4% solutions. Although it is effective in reducing the intra-ocular pressure, the side effects of dimming of vision and accommodation spasm can be disabling and mean that this treatment has largely been superceded. Pilocarpine is still used in the treatment of acute glaucoma attacks to constrict the pupil and open up the closed drainage angle. Sometimes it is necessary to constrict the pupil rapidly during the course of intraocular surgery and this is achieved by instilling acetylcholine directly into the anterior chamber. Strong meiotics run the risk of causing retinal detachment in susceptible individuals. Meiotics have been used to reverse the effect of mydriatic drops used for fundus examination, but this practice is no longer recommended as a routine because it is unnecessary and the symptoms of meiosis may make matters worse.
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