Retinal Detachments Associated With Topical Pilocarpine Use for Presbyopia

•Topical pilocarpine ophthalmic drops may be associated with a risk of retinal detachment. •We describe 3 cases of retinal detachment in 2 patients using pilocarpine drops for presbyopia. •Pilocarpine causes anterior lens migration, which may induce tractional forces on the retina. PURPOSE To present a case series of retinal detachments associated with the use of pilocarpine for presbyopia. DESIGN Multicenter case series of 3 eyes from 2 patients. RESULTS Patient 1, a 47-year-old man, presented with flashes and floaters in both eyes. The patient had started pilocarpine 1.25% drops 1 month prior for presbyopia in both eyes. He noted the onset of flashes and floaters 3 days after he initiated the drops. A dilated examination revealed an inferotemporal retinal detachment in the right eye with an associated retinal tear inferotemporally. The left eye demonstrated a retinal detachment in the superior quadrant with an associated horseshoe tear at 12 o'clock. Patient 2, a 46-year-old man, presented 5 weeks after initiating topical pilocarpine 1.25% drops for presbyopia. He noted a nasal visual field defect in his left eye that progressed to include his central vision. A dilated examination revealed a superior retinal detachment from 11 to 3 o'clock with subretinal fluid extending into the macula. CONCLUSIONS Pilocarpine and other miotics have long been suspected to be associated with an increased risk of retinal detachment. Prior to prescribing pilocarpine for presbyopia, physicians should inform patients of this potential adverse event and consider that these patients undergo a screening dilated examination, particularly if they are myopic, to determine if they are at higher risk for retinal detachment. Before the initiation of therapy, patients should be appropriately informed regarding symptoms of retinal tears or detachment, which include flashes, floaters, and visual field loss. To present a case series of retinal detachments associated with the use of pilocarpine for presbyopia. Multicenter case series of 3 eyes from 2 patients. Patient 1, a 47-year-old man, presented with flashes and floaters in both eyes. The patient had started pilocarpine 1.25% drops 1 month prior for presbyopia in both eyes. He noted the onset of flashes and floaters 3 days after he initiated the drops. A dilated examination revealed an inferotemporal retinal detachment in the right eye with an associated retinal tear inferotemporally. The left eye demonstrated a retinal detachment in the superior quadrant with an associated horseshoe tear at 12 o'clock. Patient 2, a 46-year-old man, presented 5 weeks after initiating topical pilocarpine 1.25% drops for presbyopia. He noted a nasal visual field defect in his left eye that progressed to include his central vision. A dilated examination revealed a superior retinal detachment from 11 to 3 o'clock with subretinal fluid extending into the macula. Pilocarpine and other miotics have long been suspected to be associated with an increased risk of retinal detachment. Prior to prescribing pilocarpine for presbyopia, physicians should inform patients of this potential adverse event and consider that these patients undergo a screening dilated examination, particularly if they are myopic, to determine if they are at higher risk for retinal detachment. Before the initiation of therapy, patients should be appropriately informed regarding symptoms of retinal tears or detachment, which include flashes, floaters, and visual field loss.