Toxicity of dipivalyl epinephrine.

Fourteen patients with open-angle glaucoma applied one drop 0.1% dipivalyl epinephrine topically twice daily for three years. Four of the 14 patients developed severe blepharoconjunctivitis after 17 to 26 months of exposure to this epinephrine prodrug. Two of the four patients with dipivalyl epinephrine intolerance had a history of epinephrine intolerance. Three other patients had asymptomatic conjunctival hyperemia after 30 months of dipivalyl epinephrine exposure. No patients had conjunctival pigment deposits or cardiovascular side effects. The exfoliative cytology of two patients was characterized by karyomegaly of the conjunctival epithelial cells.