Toxicity of dipivalyl epinephrine

Area of Science:

• Ophthalmology
• Ocular Pharmacology

Background:

• Glaucoma management often involves topical medications.
• Epinephrine prodrugs are used to lower intraocular pressure.
• Long-term effects of topical dipivalyl epinephrine require evaluation.

Purpose of the Study:

• To assess the safety and tolerability of long-term topical dipivalyl epinephrine use in open-angle glaucoma patients.
• To identify potential adverse effects associated with this epinephrine prodrug.

Main Methods:

• Fourteen patients with open-angle glaucoma were treated with 0.1% dipivalyl epinephrine drops twice daily for three years.
• Adverse events, including ocular surface changes and systemic effects, were monitored.

Main Results:

• Four out of 14 patients (29%) developed severe blepharoconjunctivitis.
• Two of these four patients had a history of epinephrine intolerance.
• Three additional patients experienced asymptomatic conjunctival hyperemia.
• No conjunctival pigment deposits or cardiovascular side effects were observed.
• Exfoliative cytology revealed karyomegaly in conjunctival epithelial cells of two patients.

Conclusions:

• Topical dipivalyl epinephrine can cause significant ocular surface toxicity, including severe blepharoconjunctivitis.
• Patients with a history of epinephrine intolerance may be at higher risk.
• Long-term monitoring for ocular surface adverse events is crucial for patients using this medication.