True or False: Cholinergic agonists are commonly used for chronic POAG.

• A. True
• B. False
• C. Sometimes used as first-line
• D. Not used at all

Answer: (B)

Cholinergic agonists like pilocarpine work by constricting the pupil and increasing trabecular outflow, but they are not commonly used for chronic POAG because of practical drawbacks. They require frequent dosing and cause bothersome side effects such as persistent miosis, which can blur vision in various lighting, plus headaches and brow ache. These issues make long-term adherence difficult. Modern chronic POAG management favors prostaglandin analogs and other agents that lower IOP effectively with convenient dosing and better tolerability. Pilocarpine still has a role in specific situations, most notably acute angle-closure glaucoma where rapid IOP reduction is needed, and occasionally as an adjunct in refractory cases, but it is not a mainstay for chronic management.