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NORMAN BALLIN, BERNARD BECKER, MELVIN L. GOLDMAN; Systemic Effects of Epinephrine Applied Topically to the Eye. Invest. Ophthalmol. Vis. Sci. 1966;5(2):125-129.
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The topical ocular use of epinephrine has been shown to be correlated with an increased frequency of cardiac extrasystoles. While generally considered benign, such extrasystoles provide evidence for the systemic absorption of topically applied epinephrine and a direct effect on the heart. In order to avoid the more serious cardiotoxic effects known to occur following systemic administration of epinephrine in comparable dosages, it is suggested that epinephrine be used cautiously in patients with known heart disease, hyperthyroidism, or abnormal sensitivity to the systemic effects of epinephrine
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