Which systemic anticholinergic agent is associated with dry eye and increased IOP risk?

• A. Pilocarpine
• B. Chlorpromazine
• C. Timolol
• D. Dorzolamide

Answer: (B)

Systemic anticholinergic medications reduce parasympathetic stimulation to both the lacrimal glands and the eye’s pupil/ciliary body. This leads to dryness of the eye from decreased tear production and can cause pupil dilation (mydriasis). In eyes with narrow angles, mydriasis can precipitate angle-closure or compromise aqueous humor outflow, increasing intraocular pressure. Chlorpromazine is a systemic anticholinergic agent, and its anticholinergic effects explain both dry eye symptoms and the potential for increased IOP in susceptible individuals. The other options do not act as systemic anticholinergics: pilocarpine is a muscarinic agonist that increases tear production and lowers IOP, while timolol and dorzolamide reduce IOP and are not systemic anticholinergics.