Which drug is used to reduce production of aqueous humor in glaucoma management?

• A. Timolol
• B. Pilocarpine
• C. Mannitol
• D. Acetazolamide

Answer: (A)

Reducing production of aqueous humor lowers intraocular pressure by dialing down the ciliary body’s secretory activity. Timolol is a topical nonselective beta-adrenergic blocker that blocks beta receptors in the ciliary epithelium, decreasing cAMP and the secretory processes that form aqueous humor. The result is less fluid being produced and a drop in intraocular pressure, which is why timolol is commonly used as a first-line agent to manage glaucoma by reducing production.

Pilocarpine, in contrast, works by increasing outflow through the trabecular meshwork via miosis, not by reducing production. Mannitol lowers IOP through osmotic effects and is used more as an acute, not production-targeted, measure. Acetazolamide also reduces aqueous humor formation by inhibiting carbonic anhydrase, but it is systemic rather than topical and used in different clinical contexts.