Which medication is typically not recommended for patients with angle-closure glaucoma?

Pilocarpine is typically not recommended for patients with angle-closure glaucoma because it works by constricting the pupil (miosis), which can further narrow the angle in the anterior chamber of the eye. In angle-closure glaucoma, the drainage angle between the cornea and the iris is already compromised, which can lead to increased intraocular pressure and subsequent damage to the optic nerve. While pilocarpine can lower intraocular pressure by facilitating aqueous humor outflow, its mechanism of action is counterproductive in the acute situation of angle-closure, where any further narrowing of the angle could exacerbate the condition and lead to more severe symptoms.

In contrast, medications like brimonidine, timolol, and apraclonidine are more commonly used in glaucomatous conditions and can help reduce intraocular pressure without worsening the angle closure. Brimonidine and apraclonidine are both alpha agonists that reduce aqueous humor production and increase uveoscleral outflow, while timolol is a non-selective beta-blocker that decreases aqueous humor production as well. These medications are generally more appropriate for managing intraocular pressure in patients with angle-closure glaucoma.