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Year : 1987  |  Volume : 35  |  Issue : 3  |  Page : 146-148

Comparative evaluation of pilocarpine 2% and combined guanethidine 1% & adrenaline 0.5% in the treatment of chronic simple glaucoma

Deptt of Ophthalmology, MLB Medical College, Jhansi, India

Correspondence Address:
A N Mehrotra
Deptt of Ophthalmology, MLB Medical College, Jhansi
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Source of Support: None, Conflict of Interest: None

PMID: 3507410

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This paper reports on the results of a comparative study between pilocarpine 2%, Guanethidine 1 % & adrenaline 0.5% combination over a 6 months period with each formulation. The guanethidine/-adrenaline formulation was found to be the more effective hypotensive agent of two. This study confirms the potentiating effect of adding guanethidine to adrenaline & suggests that this combination would be a useful alternative treatment to pilocarpine 2% used alone

How to cite this article:
Mehrotra A N, Jain B S, Anand G S. Comparative evaluation of pilocarpine 2% and combined guanethidine 1% & adrenaline 0.5% in the treatment of chronic simple glaucoma. Indian J Ophthalmol 1987;35:146-8

How to cite this URL:
Mehrotra A N, Jain B S, Anand G S. Comparative evaluation of pilocarpine 2% and combined guanethidine 1% & adrenaline 0.5% in the treatment of chronic simple glaucoma. Indian J Ophthalmol [serial online] 1987 [cited 2022 Oct 7];35:146-8. Available from: https://www.ijo.in/text.asp?1987/35/3/146/26194

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  Introduction Top

Adrenaline & guanethidine, both alone and in combination have been known for many years to provide a useful ocular hypotensive effect and have been widely used in the treatment of chronic simple glaucoma [1],[2],[3],[4][5].Guanethidine is a post­ganglionic adrenergic neuronal blocker which acts by impairing the release of noradrenaline from the adrenergic nerve junctions In addition to this blocking effect guanethidine sensitive recep­tor cells in the ciliary body and ciliary processes to catecholamines [6]. The drugs therefore act as synergists, so that it is reasonable to expect an enhanced action when both are used together. Reduction in the concentration of guanethidine and adrenaline also reduces the incidence of side effects, which are common when both drugs are used in higher concentrations [6],[7].

  Material and Methods Top

The study covers 72 glaucomatous eyes in 50 patients drawn from the glaucoma clinic of the Department of Ophthalmology, M.L.B. Medical College, Jhansi The patients were of either sex and age ranged between 40 = 70 years They were grouped in two

Group I : Using guanethidine and adrenaline.

Group II: Using pilocarpine.

Each group consisted of 25 patients (36 eyes). Cases for each group were selected randomly. Detailed history of ocular complaints alongwith family history and a history of various systemic diseases were recorded. Local examination was done with the help of diffuse illumination, focal illumination and slit lamp examination. The state of the anterior segment of the eye was noted and special attention was given to exclude any recent or past signs of inflammation. Only those cases were included which did not require any surgical intervention Besides these, various other examinations were also undertaken, which were

a Visual acuity.

b. Examination of the pupil.

c Intraocular pressure recording (Schiotz and

Applanation tonometry).

d. Gonioscopy.

e. Fundus examination

f. Perimetry - both central and peripheral

(Goldmann Perimeter).

Follow up of the patients was done at 2 weeks, 1 month, 3 months and 6 months At each visit the following were recorded : Ptosis (measured in mm), hyperaemia of the bulbar conjunctiva and of the eyelids, presence or absence of punctate epitheliopathy, browache, and visual acuity.

  Results Top

All the patients who began the trial completed it Our findings were considered from 3 points of view, namely reduction in intraocular pressure, side effects, and the patient's subjective com­ments A summary of the hypotensive action of the drugs is made in [Table - 1][Table - 2] at the end of six months of trial.

In group 1, there was a fall of ocular tension and the mean value for this fall was 6.24 mmHg as compared to 4.9 mmHg for Group IL Values of P and t for both groups are P = 0.05 - 0.01, t= 2.72 and P = 0.05 - 0,02, t = 2.58 respectively for group I and IL Statistically, value of P for group I eyes is highly significant while the same for group 11 is only moderately significant

  Discussion Top

Topical administration of guanethidine induces a state of chemical sympathectomy in the autono­mic nervous system of the anterior segment of the eye, rendering the postganglionic receptors hypersensitive to the action of the chemical transmitter adrenaline [2].Nagasubramanian and others (1976) also noted a late increase in outflow and a drop in ocular tension occurring over a period of weeks after treatment with adrenaline/ guanethidine combination is probably respon­sible for greater fall in IOP than with pilocarpine was seen in the present study. Side effects were also minimal with guanethidine/adrenaline combination. There is no change in pupillary diameter with these drugs Visual acuity and marked reduction of the patients visual acuity was noted in 2 patients, of group I having central lenticular opacity [Table - 4]. Symptoms of ciliary spasm were also common with pilocarpine 7.5%. These results were similar with previous reported results of Patterson a D. [3]

This study confirms a drug regimen as an alterna­tive to Pilocarpine for the long term treatment of chronic simple glaucoma

  References Top

Becker B, Petti T. Gay A : Topical epinephrine therapy of open angle glaucoma. Arch Ophthalmol, 1961; 66: 219.25.  Back to cited text no. 1
Gloster J.: Guanethidine and Glaucoma. Trans Oph­thalmoL Soc UK 1974; 94: 573-7.  Back to cited text no. 2
Patterson GD.; Paterson G.: Drug therapy of glau­coma. Br. J. Ophthalmol, 1972; 56: 288-94.  Back to cited text no. 3
Roth J.: Guanethidine and adrenaline used in chronic simple glaucoma. Br. J. Ophthalmol 1973; 56: 507­510.  Back to cited text no. 4
Romano J.: Use of guanethidine 5% and adrenaline 1% in severe open angle glaucoma Trans Ophthal­moL Soc UK, 1977; 97: 196-201.  Back to cited text no. 5
Jones DEP, Norton DA, Davies DJG : Low dosage combined adrenaline and guanethidine in chronic simple glaucoma. Trans Ophthalmol Soc. UK, 1977; 97: 192-5.  Back to cited text no. 6
Nagasuoramanian S.: Tripathi RC; Ponnooswamy D.: Gloster J.: Low concentration guanethidine and adrenaline therapy of glaucoma Trans OphthalmoL Soc UK, 1976; 96: 179-83.  Back to cited text no. 7


  [Table - 1], [Table - 2], [Table - 3], [Table - 4]


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