Adverse effects of pilocarpine administration include miosis, retinal detachment, headache, nausea, vomiting, and diarrhea. The Ocusert delivery system (Alza Corp, Palo Alto, Calif) was designed to diminish adverse effects. Nevertheless, reports have described a sudden release of pilocarpine from Ocusert reservoirs1,2 and increased release when Ocuserts have been used concomitantly with epinephrine compounds.3 We describe the ocular and systemic toxic effects of pilocarpine in a 13-year-old boy who wore an Ocusert while swimming.
An Ocusert P-20 (20 fg/h) was added to the right eye of a 60-kg, 13-year-old boy with open-angle glaucoma and intraocular pressures of 36 mm Hg OD and 30 mm Hg OS. He had been receiving betaxolol hydrochloride in both eyes twice daily. The intraocular pressure decreased to 17 mm Hg OU. Several weeks later, after swimming in a freshwater lake for approximately 3 hours with the Ocusert in place, he experienced dizziness, nausea, and