Horseshoe Retinal Tear Minutes After Use of a New Pilocarpine Formulation in a Presbyopic, Emmetropic Man

Purpose: To examine the risks associated with the use of pilocarpine hydrochloride 1.25% ophthalmic solution prescribed for presbyopia. Methods: The adverse ocular events reported after the use of pilocarpine were compared with the symptoms experienced by a 62-year-old presbyopic man shortly after he took pilocarpine. Results: Soon after instilling pilocarpine, the patient reported symptoms, including eye pain, hazy vision, and floaters. An examination showed a horseshoe retinal tear, vitreous hemorrhage, and posterior vitreous detachment, for which the patient received extensive clinical and surgical management. Conclusions: This case highlights the need for comprehensive eye examinations and patient education about the warning signs of retinal tears or detachments before prescribing pilocarpine for presbyopia. Vigilance regarding the potential rare adverse effects of this new pilocarpine ophthalmic solution is warranted.