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Echothiophate is a long-acting, irreversible acetylcholinesterase inhibitor used primarily in ophthalmic preparations. Its main indications are the reduction of elevated intraocular pressure in glaucoma and the treatment of accommodative esotropia. By inhibiting cholinesterase, it increases endogenous acetylcholine activity at parasympathetically innervated structures in the eye (iris and ciliary muscle), resulting in miosis (pupil constriction), increased outflow of aqueous humor, reduced intraocular pressure, and enhanced accommodation. The drug is administered topically as eye drops and has a prolonged duration of action due to its slow hydrolysis by cholinesterase[2][3][5][8].
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