Muscarinic receptor antagonists block the cholinergic responses of the pupillary sphincter muscle of the iris and the ciliary muscle controlling lens curvature (see Chapter 63). Thus, they dilate the pupil (mydriasis) and paralyze accommodation (cycloplegia). Locally applied atropine and scopolamine produce ocular effects of considerable duration; accommodation and pupillary reflexes may not fully recover for 7—]2 days; thus, other muscarinic antagonists with shorter durations of action are preferred as mydriatics (see Chapter 63). Muscarinic receptor antagonists administered systemically have little effect on intraocular pressure except in patients predisposed to narrow-angle glaucoma, in whom the pressure may occasionally rise dangerously.
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