2. Epinephrine

Abstract

Epinephrine is reported to reduce intraocular pressure by decreasing aqueous formation and increasing outflow facility. Because epinephrine is devoid of accommodative and miotic effects, is administered twice a day, and is accompanied by relatively minor complications, it can be used as the initial therapy for primary open angle glaucoma, as an additive to current therapy, and as part of maximal medical therapy for glaucoma. Epinephrine is contraindicated for angle-closure glaucoma and should be used with caution in patients with narrow angles. Although there is a potential for serious systemic side effects, most of the recognized side effects are not serious and are reversible with drug discontinuation. The development of dipivalyl epinephrine (DPE) as a molecule with greater ocular penetration promises to maintain this drug's therapeutic effect with a reduction in external and extraocular side effects.