Management of acute closed-angle glaucoma with miotics and timolol

The hypotensive effect of intramuscular or intravenous acetazolamide with frequent instillation of 2% or 4% pilocarpine in polyvinyl alcohol, or with single drops of pilocarpine in polyvinyl alcohol or oily vehicles, and the hypotensive effect of topical timolol alone and together with pilocarpine was investigated in the treatment of acute closed-angle glaucoma in 75 patients (81 eyes). The results showed that there was no marked difference in the hypotensive effect whether pilocarpine was used frequently or in a single dose, in different concentrations, or in different vehicles after acetazolamide. Topical timolol alone was not effective enough to control the intraocular pressure in acute closed-angle glaucoma, but a good hypotensive effect was seen when topical timolol was followed by pilocarpine. It is concluded that 1 drop of pilocarpine 3 hours after intravenous or intramuscular acetazolamide or after topical timolol may be sufficient to terminate an acute attack. Topical timolol may serve as a valuable alternative when systemic medication is contraindicated.