Bulbar conjunctival follicles associated with dipivefrin therapy.

Large bulbar conjunctival follicles developed in 12 patients who received dipivefrin therapy for prolonged periods in the management of chronic open-angle glaucoma. In four patients, the follicles encircled the limbus. Although several of the patients were taking other drugs, the follicles disappeared within one month of discontinuing only the dipivefrin therapy. Therapy was switched to epinephryl borate in some patients and to other forms of therapy in others, without incident. The clinical course, the Giemsa staining of conjunctival scrapings, the conjunctival biopsy, and the results of patch tests suggest that this is an irritant reaction to dipivefrin rather than a reaction to preservatives or an allergic reaction.