A gel form administered once a day or wafer placed under the lid once a week may help reduce these side effects. Small amounts of an adrenergic drug, such as epinephrine, may also help. Teary eyes, brow-aches, eye pain, and allergic reactions may occur. A combination of timolol and pilocarpine is more effective than either drug used alone. These drugs increase the risk of cataract development and are therefore used mostly in patients in whom cataracts have already been removed.
Retinal detachment is an uncommon but dangerous side effect in susceptible individuals.
Excessive use of these miotics may cause toxic reactions, including convulsions, muscular paralysis, and even death from respiratory failure. Because of their potential for serious side effects some authorities even prefer surgery to the use of anticholinesterase miotics. Adrenergic agonists activate muscles in the eye that dilate pupils and therefore increase outflow of aqueous fluid. Epinephrine and its derivatives belong to this class of drugs. Epinephrine can produce burning in the eyes, enlarged pupils, and allergic reactions.