Side effects of Pilocarpine are A/E –

Most guides have given option a as the answer. I have done extensive search on this. First you see the topical adverse effects of parasympathomimetic antiglaucoma drugs (from yanoff & Duker) :- Directly acting (cholinergic agonists like pilocarpine, carbachol) → Miosis, uveitis, browache, cataracts, myopia, retinal detachment, colour vision changes, angle closure, ocular cicatracial pemphigoid. Indirectly acting (anticholineesterases like demecarium) :- Intense miosis, iris pigment cysts, punctal stenosis, myopia, cataract, retinal detachment, angle closure. Now see each option sequentially :- Option '1' Pilocarpine can cause shallow anterior chamber :- "The use of pilocarpine is somewhat paradoxical since it is known to cause further shallowing of anterior chamber".  — Evidence - based ophthalmology. Now you must be thinking then why pilocarpine is the drug of choice for angle closure glaucoma. Pilocarpine works by helping to open the angle by tensing the iris-diaphragm and pulling on the scleral spur. It may also help to resolve relative pupil block. Option '2' Punctal stenosis is caused by indirect cholinomimetic (cholinesterase) not by direct cholinomimetic (pilocarpine). Option '3' Rarely, pilocarpine can cause follicular conjunctivitis :- "Pilocarpine and carbachol may both cause conjunctival follicle". — Clinical ophthalmology. Option '4' Miotics (pilocarpine) makes the iris thin and pulls it away from lens removing the pupillary block, increasing the chances of posterior synechiae (due to stretching & increased surface of iris) and restoring aqueous flow by opening irido-corneal angle.