Drop attack in glaucoma. The Melbourne experience with topical miotics, adrenergic and neuronal blocking drops

We have considered the effectiveness of miotics (pilocarpine 2% and ecothiopate iodide (Phospholine Iodide) 0.125 or 0.25%), adrenaline (Eppy/N 1%) or adrenaline precursors (dipivalyl epinephrine or dipivefrin hydrochloride (Propine) 0.1%) and neuronal blockers (timolol maleate (Timoptol) 0.5%) in 165 patients in the clinical situation. All drops were effective in lowering intraocular pressure with an average fall of 6.6 mmHg for timolol (160 eyes), 8.21 mmHg for pilocarpine (79 eyes), 5.77 mmHg for dipivalyl epinephrine (57 eyes), 7.23 mmHg for adrenaline (17 eyes) and 10.5 mmHg for ecothiopate iodide (16 eyes). In chronic simple open-angle glaucoma, ocular hypertension and pseudoexfoliative glaucoma, pilocarpine and timolol were almost equally effective while dipivalyl epinephrine and adrenaline were also effective, but more as additive therapy, though dipivalyl epinephrine may be useful on its own in ocular hypertension. In low-tension glaucoma timolol and dipivalyl epinephrine together seemed best, while in secondary glaucomas all were effective at times, but ecothiopate iodide was best in aphakic glaucoma and fluorometholone (FML Liquifilm) 0.1% was important in inflammatory glaucoma. Side effects were frequent with dipivalyl epinephrine and timolol, with respiratory disease a strong contraindication to timolol.