Intraocular pressure increases with dopamine infusion in critically ill patients

Introduction: A recently released DA-1 receptor agonist, fenoldopam, has demonstrated the side effect of increasing intraocular pressure (IOP) in both healthy volunteers and patients with chronic ocular hypertension. Dopamine (DA) is frequently infused in critically ill patients for both its inotropic and naturietic effects. As DA is a potent agonist at both DA-1 and DA-2 receptors, we hypothesized that commonly used doses would significantly increase IOP. Methods: Patients in the intensive care unit (ICU) either about to start or already on DA infusions (≤5μg/kg/min) were studied. Written informed consent was obtained. Local anesthesia was obtained with one drop of proparacaine HCl 0.5% in each eye. IOP was measured in both eyes using a Tono-Pen XL (Bio-Rad, Glendale, CA). Baseline IOP was measured either prior to initiation of DA or after termination of the infusion. IOP was measured daily for up to 4 days during DA infusion and measurements were obtained by the same 2 observers. Data are expressed as mean increase from baseline and were compared by paired t-test. P<0.05 was considered significant. Results: Twenty-seven patients received a mean DA infusion of 2.56±0.22 μg/kg/min. IOP was significantly higher in critically ill patients while receiving DA infusions than compared to baseline (table). Comparable results were seen in both eyes and on days 3 and 4. Table. Mean Increase in Intraocular Pressure on Dopamine*p<0.05 Left Eye(mmHg) Right Eye(mmHg) n Day 1 4.3*4.4*27 Day 2 3.9*4.5*16 Discussion: We have shown that DA infusion consistently increases IOP in ICU patients. The relative increase is similar to that previously reported with fenoldopam. Practitioners should be aware of this effect on IOP with commonly used doses of DA and extra caution may be warranted in patients with a history of elevated IOP or glaucoma.