From the Guidelines
The recommended dose of pilocarpine for treating dilated pupils is 1.25% pilocarpine ophthalmic solution, as approved by the FDA for daily use to treat presbyopia. This dose has been shown to be effective in managing presbyopia, and by extension, can be used to treat dilated pupils 1. The use of pilocarpine for this purpose is supported by recent clinical trials, which have demonstrated promising results.
- Key considerations when using pilocarpine include the risk of retinal detachment and retinal tear, particularly in individuals with pre-existing retinal disease 1.
- A dilated fundus examination is advised in all patients prior to initiation of therapy to look for holes, tears, or breaks in the retina.
- Patients should be aware of potential side effects, including temporary blurred vision, browache, or dim vision, especially in low light conditions.
- Pilocarpine should be used with caution in patients with retinal detachment, acute iritis, or acute inflammatory disease of the anterior chamber.
- If symptoms worsen or if the pupil does not respond to treatment within 24 hours, patients should seek immediate ophthalmological care.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION: The initial dose is one or two drops in the affected eye(s). This may be repeated up to three or four times daily or as directed by a physician. The recommended dose of pilocarpine for treating dilated pupils is one or two drops in the affected eye(s), repeated up to three or four times daily as directed by a physician 2.
From the Research
Pilocarpine Dosage for Dilated Pupils
The recommended dose of pilocarpine for treating dilated pupils varies depending on the specific condition and the individual patient.
- For glaucoma treatment, a study 3 compared the efficacy and safety of 4% pilocarpine gel and 1% pilocarpine solution, with the 4% pilocarpine gel being used once per night.
- In the context of reversing tropicamide mydriasis, a study 4 used single instillations of 1% and 2% pilocarpine.
- For anisocoria diagnosis, a case report 5 applied 0.125% and 1% pilocarpine to exclude oculomotor nerve palsy.
- In the treatment of angle closure glaucoma, a study 6 used intravenous acetazolamide and pilocarpine to rapidly return pressure to normal levels, but the exact dosage of pilocarpine is not specified.
- For the diagnosis of Adie's tonic pupil, a study 7 compared the diagnostic ability of 0.125% and 0.0625% dilute pilocarpine, with the 0.0625% concentration showing better diagnostic accuracy.
Key Findings
- The dosage of pilocarpine used can vary from 0.0625% to 4%, depending on the specific condition and application.
- Pilocarpine can be used to treat glaucoma, reverse mydriasis, diagnose anisocoria, and treat angle closure glaucoma.
- The diagnostic accuracy of pilocarpine for detecting denervation supersensitivity in Adie's tonic pupil is concentration-dependent, with 0.0625% being more accurate than 0.125% 7.