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Direct-Acting Cholinergic Agonists: Therapeutic Uses

Direct-acting cholinergic agonists have many therapeutic uses in various medical fields. Choline esters, including acetylcholine, have limited clinical utility due to their non-selectivity and short duration of action. Still, acetylcholine and carbachol are applied topically during ophthalmologic surgery to induce miosis. Pilocarpine, a muscarinic and ganglionic stimulator, effectively treats open-angle glaucoma and alleviates xerostomia and dry mouth caused by radiotherapy or Sjögren syndrome.
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The muscles of the eye are sophisticated structures that control eye movement and focus, allowing for the precise and rapid adjustments necessary for vision. The human eye is controlled by ten muscles — six extraocular muscles, three intraocular muscles, and one primary eyelid retractor muscle.
Extraocular Muscles
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Angle Closure Glaucoma: Treatment

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Open Angle Glaucoma: Treatment

In open-angle glaucoma, the iridocorneal angle remains open, but the trabecular meshwork becomes stiff, slowing down the outflow of aqueous humor. This causes a buildup of aqueous humor in the anterior chamber, leading to a sudden increase in intraocular pressure. The treatment for open-angle glaucoma focuses on reducing the elevated intraocular pressure by either decreasing the secretion of aqueous humor or increasing its outflow.
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Myasthenia Gravis: Overview and Treatment

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Updated: May 9, 2026

Surgical Correction for Pediatric Epiblepharon and Trichiasis
03:59

Surgical Correction for Pediatric Epiblepharon and Trichiasis

Published on: July 8, 2025

Myectomy for blepharospasm 2013.

Brett Pariseau1, Michael W Worley, Richard L Anderson

  • 1Center for Facial Appearances, Salt Lake City, Utah 84102, USA.

Current Opinion in Ophthalmology
|August 9, 2013
PubMed
Summary
This summary is machine-generated.

Myectomy is a crucial surgical option for blepharospasm when botulinum toxin (BTX) injections fail or are unsuitable. It is particularly indicated for patients with eyelid opening apraxia (ALO) and BTX-resistant cases.

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Iris Fixation via External Pentagram Suturing
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Iris Fixation via External Pentagram Suturing

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Last Updated: May 9, 2026

Surgical Correction for Pediatric Epiblepharon and Trichiasis
03:59

Surgical Correction for Pediatric Epiblepharon and Trichiasis

Published on: July 8, 2025

Iris Fixation via External Pentagram Suturing
05:22

Iris Fixation via External Pentagram Suturing

Published on: May 5, 2022

Area of Science:

  • Ophthalmology
  • Neurology
  • Surgical Procedures

Background:

  • Botulinum toxin (BTX) is a primary treatment for facial dystonias like benign essential blepharospasm (BEB).
  • BTX injections are not universally effective, necessitating alternative treatments for some patients.

Purpose of the Study:

  • This review focuses on the indications and surgical techniques for myectomy in treating BEB.
  • It specifically addresses myectomy for patients with apraxia of eyelid opening (ALO).

Main Methods:

  • The review synthesizes current literature on myectomy for BEB and ALO.
  • It outlines the surgical approach and patient selection criteria for myectomy.

Main Results:

  • Myectomy is indicated for BEB patients with associated ALO.
  • It is also considered for those with blepharospasm-associated deformities.
  • Patients unresponsive to BTX, or unable to afford/refuse BTX, are also candidates for myectomy.

Conclusions:

  • Myectomy remains a vital surgical intervention for managing blepharospasm.
  • The most frequent indication for myectomy in BEB patients is the presence of associated ALO.