Corneal edema and the intraocular use of epinephrine

Commercially prepared dilutions (1:10,000) of epinephrine can cause marked increases in corneal thickness and loss of corneal endothelial cells when injected into the anterior chamber of the eye. Endothelial toxicity is related to the buffer capacity of the epinephrine solution, which is in turn controlled by the concentration of the antioxidant (sodium bisulfite) as well as by the vehicle formulation and a low pH value.