Which should not be used in raised IOT associated with uveitis –
**Core Concept**
Raised intraocular pressure (IOT) is a common complication of uveitis, an inflammatory condition affecting the uvea, the middle layer of the eye. Managing IOT in uveitis requires careful consideration of the underlying pathophysiology and potential side effects of treatment.
**Why the Correct Answer is Right**
In uveitis, raised IOT is often due to inflammation-induced ciliary body dysfunction, leading to increased aqueous humor production and impaired outflow. The primary goal of treatment is to reduce inflammation while minimizing the risk of further increasing IOT. **Pilocarpine**, a direct-acting muscarinic receptor agonist, is typically used to decrease IOT by increasing aqueous humor outflow. However, in uveitis, **pilocarpine** can exacerbate inflammation by inducing miosis, which may worsen the condition. Therefore, **pilocarpine** should not be used in raised IOT associated with uveitis.
**Why Each Wrong Option is Incorrect**
**Option A:** **Atropine** is actually used in uveitis to dilate the pupil and reduce pain, but it can also increase IOT. However, it is not the correct answer because it is not as directly contraindicated as **pilocarpine**.
**Option B:** **Brimonidine** is an alpha-2 adrenergic agonist that decreases IOT by reducing aqueous humor production. It is not typically used in uveitis, but it is not the correct answer because it is not directly contraindicated in this condition.
**Option C:** **Timolol** is a beta-blocker that decreases IOT by reducing aqueous humor production. It is not typically used in uveitis, but it is not the correct answer because it is not directly contraindicated in this condition.
**Clinical Pearl / High-Yield Fact**
When managing raised IOT in uveitis, always consider the potential effects of treatment on inflammation and IOT. In general, **miotics** like **pilocarpine** should be avoided, and **mydriatics** like **atropine** may be used cautiously.
**Correct Answer: A. Pilocarpine**