Comparison of action of cholinergic and anticholinesterase agents in glaucoma

The cholinergic agents have the advantages of systemic safety, fewer undesirable local side effects, and usefulness in angle-closure and narrow-angle glaucoma. The powerful cholinesterase inhibitors, on the other hand, produce better diurnal reduction of intraocular pressure, require less frequent administration, and can control many cases whose pressures cannot be otherwise brought to heal. Neither group constitutes the ideal agent, and the search for this must therefore continue. It must always be kept in mind that the agents used are powerful toxic drugs and for some people may be incapacitating. One must not be afraid to use them when indicated, but they should not be used indiscriminately.