Instillation of epinephrine hydrochloride solution (1:1,000) into the conjunctiva of a normal person will not produce any change in the size of the pupil except a dilatation of 2 to 4 mm. Many years ago Loewi1 noticed that in dogs instillation of this drug after removal of the pancreas gave rise to a distinct, sometimes maximum, mydriasis. Sometimes the eyeball protruded and the eyelids could not meet. Undoubtedly, these signs pointed to an increased activity of the sympathetic fibers innervating the dilator pupillae, the tarsalis superior and inferior and the orbitalis muscles. It was interesting that in cases of severe diabetes with acidotic coma, Loewi could detect the same mydriatic effect after the instillation of epinephrine hydrochloride. As far as my experience goes, I observed a Loewi reaction so frequently in comatose diabetic patients during my work in the clinics of Chvostek and Noorden (mostly in the era before
HESS L. EPINEPHRINE MYDRIASIS. Arch Ophthalmol. 1943;30(2):194–195. doi:10.1001/archopht.1943.00880200042003
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