There is a general belief among ophthalmologists1 that the instillation of epinephrine hydrochloride into the conjunctival sacs causes dilatation of the pupils. This is contrary to the findings of Loewi,2 one of the winners of the Nobel prize in medicine and physiology in 1936. He has shown that when epinephrine hydrochloride is instilled into the conjunctival sacs of normal persons no mydriasis will ensue. However, if the sympathetic nervous system is rendered hyperirritable, as may occur in persons with exophthalmic goiter or diabetes, dilatation of the pupils will become apparent. In applying this test to many hundreds of patients in the Manhattan Eye, Ear and Throat Hospital during the last eighteen years, I have found the observations of Loewi to be correct. Moreover, I have noticed other conditions that may produce unilateral hyperirritability of the sympathetic nervous system of the eye and unilateral dilatation of the pupil
HUBERT L. DIAGNOSTIC SIGNIFICANCE OF EPINEPHRINE INSTILLED INTO CONJUNCTIVAL SACS. Arch Ophthalmol. 1937;17(6):1076–1084. doi:10.1001/archopht.1937.00850060132012
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