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October 31, 2006

Worst Pills, Best Pills Newsletter article November, 2006

New studies of beta-blocker eye drops, which are used to treat blindness-causing glaucoma, show that the eye drops may cause deaths, heart attacks, serious drops in blood pressure, fainting spells and other complications in patients.

A commentary published in the September 2 issue of The Lancet , a prestigious medical journal, reviewed the cardiovascular and respiratory complications associated with beta-blocker eye drops. Beta-blocker eye drops are very effective in controlling elevated pressure in the eyes caused by glaucoma. A list of the beta-blocker eye drops currently available in this country accompanies this article. (Beta-blockers can also be taken orally, and in this form they are frequently prescribed to treat high-blood pressure.)


Generic Name












Timolol with Dorzolamide


However, The Lancet commentators noted that it is a mistake to consider the beta-blocker eye drops totally safe. Beta-blocker eye drops are known to cause many cardiovascular  complications including low blood pressure, heart rhythm disturbances, fainting spells and heart attacks. Beta-blocker eye drops have also been reported to be one of the most common causes of falls in elderly glaucoma patients because the drugs can cause a drop in blood pressure.

In addition, an Australian study published in the July 2006 issue of the journal Ophthalmology suggested an increased risk of cardiovascular death in glaucoma patients using beta-blocker eye drops. The study, which looked at eye diseases in general, involved 3,654 individuals ranging in age from 47 to 94 years old and ran from 1992 through January 2002.

At the beginning of the study, 108 (three percent) of the participants were diagnosed with glaucoma. There were 873 deaths in the 3,654 participants, and of these, 312 (8.5 percent) died of cardiovascular events such as heart attacks and strokes.

According to the study, deaths due to cardiovascular causes were seen in 14.6 percent of the glaucoma patients and in 8.4 percent in those without glaucoma, which is not a statistically significant difference in cardiovascular deaths. However, the results did show that cardiovascular death was statistically significantly higher in those who began the study with a diagnosis of glaucoma and particularly in those also using timolol (TIMOPTIC) eye drops.

The authors of the Australian study concluded that the:

Findings from the Blue Mountains Eye Study demonstrate an increased cardiovascular mortality in persons with previously diagnosed glaucoma. There was a suggestion of higher cardiovascular mortality in glaucoma patients using topical timolol that merits further study.


Other problems with beta-blockers
Beta-blocker eye drugs can also cause breathing problems in patients without an existing or prior history of asthma or chronic obstructive pulmonary disorder. The August 1995 issue of Worst Pills, Best Pills News  reported research published in The Lancet on June 25, 1995, which found that timolol eye drops caused a decrease in breathing function and the ability to exercise in older adults, even in those without a previous history of asthma or breathing problems.  

In Worst Pills, Best Pills News February 2003 we presented research from the December 14, 2002, British Medical Journal , which showed that 12 months after being prescribed beta blocker eye drops, 1.9 percent more patients in a group of study participants with no previous breathing problems were receiving a new drug to treat asthma. This translates to one patient in 55 being treated with a topical beta-blocker developing breathing disorder that required treatment with a new drug.

Three and three-tenths (3.3) percent more patients in the group that did have a new diagnosis of asthma or chronic obstructive pulmonary disorder when starting the beta-blocker, were subsequently treated with a new drug for asthma than the study’s control patients. This computes to one patient in 30 who was treated with a topical beta-blocker for one year requiring a new drug for breathing problems and being diagnosed with asthma or chronic obstructive pulmonary disorder .

How do beta-blocker eye drops cause serious complications in other parts of the body? When oral beta-blockers are absorbed and get into the blood, they are immediately taken to the liver where they are broken down before being distributed to the rest of the body (known as the first pass effect). On the other hand, the beta-blockers in eye drops enter a canal that runs from the corner of eye to the nose, called the nasolacrimal canal, where they bypass the liver and are directly absorbed into the blood leading to high beta-blocker levels and possible adverse reactions.

What You Can Do
You should only use beta-blocker eye drops in the lowest possible dose to control the increased eye pressure from glaucoma (see Worst Pills, Best Pills News September 2006 about using a smaller number of eye drops).

You should not use beta blocker eye drops to treat glaucoma if you have pre-existing breathing or certain heart conditions.

If you experience falls or fainting spells after starting treatment with a beta-blocker eye drop for glaucoma, contact your physician immediately.

If you have not previously had a breathing problem and have been prescribed beta-blocker eye drops for glaucoma and experience breathing difficulties, contact your physician immediately.