Enhanced ocular hypotensive response to epinephrine with prior dexamethasone treatment

In 12 patients with ocular hypertension and similar pressures in each eye, one eye was randomly selected in a masked manner for pretreatment with three applications of topical 0.01% dexamethasone sodium phosphate drops prepared in artificial tears. The other eye was treated with three applications of drops of artificial tears alone. Both eyes were then treated with 0.1% epinephrine hydrochloride drops. Ocular pressures were measured for the next 2 hours at 20-minute intervals. When compared with eyes treated with epinephrine drops alone, eyes pretreated with dexamethasone drops showed a significantly greater decrease in pressure (mean [+/- SD] maximum difference, 3.1 +/- 2.1 mm Hg). Five patients had a difference of 1.0 to 4.0 mm Hg and five patients had a difference of 4.0 to 6.0 mm Hg. Two patients showed no response. Younger age was associated with the greater response. Adrenergic-glucocorticoid synergism resulting in the lowering of ocular pressure may offer a potential for therapeutic use in ocular hypertension and glaucoma.