Enhanced ocular hypotensive response to epinephrine with prior dexamethasone treatment

N. Bealka and B. Schwartz
Department of Ophthalmology, New England Medical Center Hospitals, Boston, MA 02111.

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.