Understanding the Role of Pilocarpine: Does Pilocarpine Increase Tear Production?

October 10, 2025 •

3 min read

An estimated 17 million adults in the U.S. suffer from dry eye syndrome, a condition that can significantly impact daily life. For those with aqueous-deficient dry eye, particularly associated with Sjögren's syndrome, the medication pilocarpine can be an effective treatment, as it does increase tear production when taken orally.

Quick Summary

Pilocarpine, a cholinergic agonist, stimulates exocrine glands, including the lacrimal glands, to increase tear production when taken orally. It is effectively used to treat dry eye symptoms in Sjögren's syndrome, though its topical application for glaucoma does not have this effect. Effectiveness depends on the route of administration, and potential side effects should be considered.

Key Points

Oral Pilocarpine Increases Tears: When taken orally, pilocarpine stimulates the body's exocrine glands, including the lacrimal glands, to produce more tears.
Oral vs. Topical: The effect of oral pilocarpine (Salagen) is distinct from topical pilocarpine eye drops, which are primarily for glaucoma and can worsen dry eye.
Effective for Sjögren's: Oral pilocarpine is an effective treatment for dry eyes caused by Sjögren's syndrome, significantly improving symptoms and tear production.
Common Side Effects: The most frequent side effects are cholinergic in nature, such as increased sweating, nausea, and flushing, and are often related to the amount taken.
Not a First-Line Treatment: Unlike artificial tears, pilocarpine is a systemic medication reserved for cases of aqueous-deficient dry eye where glandular function is compromised.
Improves Tear Film Quality: In addition to increasing tear volume, pilocarpine can also improve the stability and quality of the tear film.

How Pilocarpine Works to Increase Tear Production

Pilocarpine is a direct-acting parasympathomimetic agent that mimics acetylcholine, a neurotransmitter involved in regulating exocrine gland secretions, including those from the lacrimal glands. When taken orally, pilocarpine activates muscarinic receptors on these glands, prompting them to increase the production of aqueous tears. This systemic effect helps address aqueous-deficient dry eye by boosting tear volume.

Oral vs. Topical Pilocarpine: A Critical Distinction

It's important to distinguish between oral and topical pilocarpine. Oral pilocarpine increases systemic secretions, including tears, while topical pilocarpine eye drops are primarily used for glaucoma to reduce intraocular pressure. Topical application can negatively impact meibomian gland function and worsen dry eye symptoms.

Clinical Evidence for Oral Pilocarpine in Dry Eye

Clinical trials, especially in patients with Sjögren's syndrome, support the use of oral pilocarpine for dry eye. Studies indicate significant improvements in dry eye symptoms and increased tear secretion. Research also suggests pilocarpine can improve tear film quality and stability.

Potential Side Effects of Pilocarpine

Due to its effects on muscarinic receptors throughout the body, oral pilocarpine can cause side effects, typically mild to moderate and related to the amount taken. Common side effects include sweating, nausea, rhinitis, flushing, chills, increased urination, and headache. These are often manageable, but more severe side effects may necessitate adjustments or alternative treatments.

How Pilocarpine Compares to Other Dry Eye Treatments

Pilocarpine offers a systemic approach to increasing tear production, differing from many topical dry eye treatments. The best treatment depends on the cause and severity of the dry eye.

Comparison of Dry Eye Treatments


Treatment Type	Mechanism of Action	Best For	Potential Side Effects
Oral Pilocarpine	Systemic stimulation of lacrimal glands to increase aqueous tear secretion via muscarinic receptors.	Aqueous-deficient dry eye, especially in Sjögren's syndrome.	Sweating, nausea, flushing, increased urination.
Cyclosporine/Lifitegrast	Immunosuppressant eye drops that reduce inflammation on the eye surface to increase natural tear production.	Moderate to severe dry eye caused by inflammation.	Eye irritation, burning, redness, temporary visual changes.
Artificial Tears	Topical lubricants that temporarily supplement the tear film.	Mild to moderate dry eye symptoms for quick, short-term relief.	Ocular irritation, blurred vision (typically transient).
Corticosteroid Drops	Strong anti-inflammatory eye drops for short-term use to reduce inflammation.	Severe, short-term flare-ups of inflammation.	Increased intraocular pressure with long-term use.

Is Pilocarpine Right for You?

Pilocarpine can be a valuable treatment for increasing tear production, particularly for conditions like Sjögren's syndrome where glandular function is impaired. Unlike artificial tears, which offer temporary relief, pilocarpine provides a systemic solution by stimulating tear production from within. However, the possibility of cholinergic side effects like sweating and nausea should be considered. Your doctor will evaluate your health and any potential contraindications, such as uncontrolled asthma or narrow-angle glaucoma, before prescribing pilocarpine. Treatment requires consistent use, and benefits may take several weeks to appear. Always consult your healthcare provider to determine the most suitable dry eye treatment for your needs.

Oral pilocarpine for the treatment of dry eye in patients with Sjögren's syndrome

Frequently Asked Questions

Pilocarpine is a cholinergic agonist medication that mimics the effect of acetylcholine. When taken orally, it stimulates muscarinic receptors on exocrine glands, prompting increased tear production from the lacrimal glands and offering relief from dry eye symptoms.

Oral pilocarpine and artificial tears serve different purposes. While artificial tears provide temporary, surface-level lubrication, oral pilocarpine works systemically to increase the body's own tear production. The choice depends on the cause and severity of the dry eye, with pilocarpine being more suitable for conditions like Sjögren's syndrome where tear production is fundamentally low.

Common side effects include increased sweating, nausea, rhinitis (runny nose), flushing, and increased urination. These side effects are related to its cholinergic activity and can be related to the amount taken.

No, topical pilocarpine eye drops are primarily used for glaucoma and can actually worsen dry eye. They can affect the meibomian glands, which are crucial for the oily layer of the tear film, leading to a less stable tear film and increased evaporation.

While some patients experience initial benefits sooner, studies show that several weeks of consistent treatment with oral pilocarpine may be necessary to assess its full beneficial response for dry eye symptoms.

Pilocarpine should be used with caution or avoided in individuals with certain conditions, including poorly controlled asthma, narrow-angle glaucoma, and severe hepatic impairment. A thorough medical evaluation by a healthcare provider is necessary before starting treatment.

For dry eye associated with Sjögren's syndrome, pilocarpine is used orally. A healthcare professional will determine the appropriate amount and frequency of administration for this condition.