Pilocar Eye Drop
Pilocar (pilocarpine 1% / 2% / 4%) — cholinergic miotic eye drop. Acute angle-closure glaucoma rescue and chronic IOP control. High-myope retinal-detachment caution.
✓ Medically reviewed by Morgan Ellis — Pharmacy Researcher · 8 years experience · Last reviewed: May 2026
⚡ Quick Answer — What is Pilocar Eye Drop?
Pilocar Eye Drop is pilocarpine 2%, a cholinergic miotic that lowers eye pressure by constricting the pupil and pulling the iris off the trabecular meshwork. Used in acute angle-closure glaucoma, post-iridotomy, and rarely in chronic glaucoma. Causes pupil constriction, brow ache, and dim vision.
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What is Pilocar Eye Drop?
Pilocar Eye Drop is manufactured by Sunways and contains pilocarpine HCl 2% as a sterile ophthalmic solution. Pilocarpine is a parasympathomimetic miotic — it constricts the pupil and contracts the ciliary muscle, opening the trabecular meshwork and increasing aqueous outflow. It was the first effective glaucoma medication (used since the 1870s) but has been largely superseded by drops with better tolerability. It retains a critical role in acute angle-closure attacks and after laser iridotomy.
How It Works
Pilocarpine activates muscarinic M3 receptors on the iris sphincter (constricting the pupil) and the ciliary muscle (contracting it). The mechanical pull of the contracting ciliary muscle opens the spaces of the trabecular meshwork, increasing conventional outflow of aqueous humour. In angle-closure glaucoma, pupil constriction also pulls the peripheral iris away from the trabecular meshwork, breaking the angle closure.
Indications
- Acute angle-closure glaucoma: emergency use to break the attack while definitive laser iridotomy is arranged
- Post-iridotomy in narrow-angle eyes, before laser is performed
- Diagnostic test for Adie’s tonic pupil (low-dose 0.1% — denervation supersensitivity)
- Chronic open-angle glaucoma: rarely now — only when other classes fail and patient tolerates side effects
- Off-label cosmetic miosis (presbyopia management): low-dose 1.25% formulations are FDA-approved (Vuity)
Dosing
| Indication | Dose |
|---|---|
| Acute angle-closure attack | 1 drop every 5–10 minutes for the first hour, then 1 drop every 1–4 hours. Pilocarpine works only when iris ischaemia from very high IOP is reversed first — so initial therapy includes oral acetazolamide and topical beta-blocker. |
| Chronic glaucoma | 1 drop four times daily (every 6 hours) |
| After laser iridotomy | 1 drop on day of procedure, may continue 1–4× daily if angle still narrow |
Side Effects
Visual: dim vision (constricted pupil reduces light entering the eye — pronounced at night and indoors), brow ache (ciliary spasm — usually settles after 2–4 weeks of continuous use), induced myopia (ciliary contraction shifts accommodation), reduced peripheral vision.
Other ocular: conjunctival hyperaemia, lacrimation, retinal detachment risk in high myopes (vitreous traction from ciliary contraction), follicular conjunctivitis with chronic use.
Systemic (rare with eye drops): sweating, salivation, GI cramping, bronchospasm.
Warnings & Contraindications
- Acute uveitis — pupillary constriction can worsen posterior synechiae formation
- High myopia, lattice degeneration, prior retinal tear — relative contraindication, dilated retinal exam first
- Severe asthma or COPD — possible bronchospasm
- Severe bradycardia, recent MI
- Acute iritis
- Pregnancy / breastfeeding — discuss with specialist
Storage
Store at 15–25°C protected from light. Discard 28 days after first opening.
Frequently Asked Questions
Why is my vision dim with Pilocar Eye Drop?
Pilocarpine constricts the pupil, reducing the amount of light entering the eye. The effect is most pronounced in dim or evening light. This is expected and reversible when the drop is stopped.
What is the brow ache?
Pilocarpine contracts the ciliary muscle, causing referred pain in the brow that feels like a tension headache. The discomfort usually settles after 2–4 weeks of continuous use as the muscle adapts.
Can I drive after Pilocar Eye Drop?
Avoid driving until you know how it affects your vision, especially at night. Constricted pupils make night driving difficult — most patients on chronic pilocarpine cannot drive after dark.
When is pilocarpine used in modern glaucoma care?
Acute angle-closure attack as a temporising measure before iridotomy; rare chronic-glaucoma patients who tolerate it; post-iridotomy when the angle is still narrow; new low-dose formulations for presbyopia (Vuity).
Is Pilocar Eye Drop safe in pregnancy?
Avoid unless an ophthalmologist judges the benefit outweighs the risk. Limited human data.
What is induced myopia?
Ciliary contraction shifts accommodation toward near vision, making distance vision blurry. The effect is usually reversible.
Why are high myopes at higher retinal-detachment risk?
High-myopic eyes have thinner peripheral retina with more lattice degeneration. Ciliary contraction transmits force to the vitreous base, which can pull on weakened retina and trigger a tear. Have a dilated retinal exam before starting if you are highly myopic.
Can I use Pilocar Eye Drop with other glaucoma drops?
Yes — pilocarpine is additive with all other classes. Wait 5 minutes between bottles.
What is acute angle-closure glaucoma?
A medical emergency where the iris suddenly blocks aqueous outflow at the angle, causing IOP to spike to 50–80 mmHg. Symptoms include severe eye pain, blurred vision, halos around lights, nausea, and a fixed mid-dilated pupil. Requires same-day ophthalmology assessment and laser iridotomy.
What if I miss a dose?
For chronic dosing, take it as soon as you remember unless the next dose is close. For acute attack management, follow the specific instructions of your ophthalmologist.
Other Eye-Care Medications
Customers viewing this product also consider these alternatives in our Eye Care range:
- Xalatan Eye Drop (latanoprost)
- Azopt Eye Drops (brinzolamide)
- Alphagan P Drop (brimonidine)
- Iotim Eye Drops (timolol)
- Careprost (bimatoprost)
Medical Disclaimer
The information on this page is for educational purposes only and is not a substitute for medical advice from a qualified ophthalmologist or optometrist. Eye conditions can rapidly threaten sight — sudden vision loss, severe pain, or trauma is an ophthalmology emergency. Always consult an eye-care professional before starting, stopping, or changing any treatment.
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| Strength | 2% (5 ml) Eye Drop |
|---|---|
| Quantity | 1 Bottle/s, 3 Bottle/s, 6 Bottle/s |
| Pharma Form | Eye Drop/s |
| Manufacturer | Glaucoma |
| Treatment | Eye Care |
| Generic Brand | Pilocarpine |
Pilocar Eye Drop
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