Bleiman B S, Schwartz A L
Arch Ophthalmol. 1979 Jul;97(7):1305-6. doi: 10.1001/archopht.1979.01020020047010.
A patient with unilateral angle-recession glaucoma had an ipsilateral increased intraocular pressure (IOP) with miotics despite open angles, and decreased IOP with cycloplegics. The following mechanism is proposed to explain these findings: Pilocarpine hydrochloride has been demonstrated experimentally to increase trabecular outflow and decrease uveoscleral outflow. In this eye with a severely compromised and unresponsive trabecular outflow, miotics served to impair uveoscleral outflow and cause a net rise in IOP. Similarly, an increase in uveoscleral outflow with cycloplegics served to decrease IOP. The use of atrophine sulfate in these rate cases may be of therapeutic value in lieu of systemic or surgical therapy.
一名单侧房角后退性青光眼患者，尽管房角开放，但使用缩瞳剂后同侧眼压升高，而使用睫状肌麻痹剂后眼压降低。提出以下机制来解释这些发现：实验证明，盐酸毛果芸香碱可增加小梁网房水流出并减少葡萄膜巩膜途径房水流出。在这只小梁网房水流出严重受损且无反应的眼中，缩瞳剂会损害葡萄膜巩膜途径房水流出并导致眼压净升高。同样，睫状肌麻痹剂使葡萄膜巩膜途径房水流出增加，从而降低眼压。在这些病例中，使用硫酸阿托品代替全身治疗或手术治疗可能具有治疗价值。
