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Medical Author:

Andrew A. Dahl, MD, FACS

Andrew A. Dahl, MD, FACS

Andrew A. Dahl, MD, is a board-certified ophthalmologist. Dr. Dahl's educational background includes a BA with Honors and Distinction from Wesleyan University, Middletown, CT, and an MD from Cornell University, where he was selected for Alpha Omega Alpha, the national medical honor society. He had an internal medical internship at the New York Hospital/Cornell Medical Center.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Beta adrenergic blockers, administered as eye drops, became available in the late 1970s and quickly became the most commonly used drug for the treatment of glaucoma. Since the advent of the prostaglandin group of drugs, beta adrenergic locking drops have become the second most widely used therapy. This group includes timolol (Timoptic Betimol, Istalol), levobunolol (Betagan, AKBeta), betaxolol (Betoptic), carteolol (Ocupress), and metipranolol (OptiPranolol). Timolol is currently available in a generic form.

How beta blockers work: These drugs lower intraocular pressure by reducing the amount of aqueous humor produced.

Most adrenergic beta blockers are nonselective and block both the beta-1 and beta-2 receptors. A nonselective blocker inhibits both heart muscle and opening of the airways of the lungs. These are, therefore, contraindicated in patients with asthma, emphysema, chronic obstructive pulmonary disease (COPD), bradycardia (low pulse rate), and congestive heart failure. Betaxolol (Betoptic) is a selective beta-1 receptor antagonist. Its mechanism of action is similar to timolol, but since it is a selective beta-1 blocker, it is better tolerated in patients with lung disease than timolol.

Who should not use these medications:

• Persons allergic to beta blockers or sulfites
• Persons with asthma or chronic obstructive pulmonary disease
• Persons with severe heart failure
• Persons with dangerously abnormal heart rhythms

Use: These drugs are administered as eye drops to the affected eye(s).

Drug or food interactions: Ocular beta blockers may have additive effects when used with oral beta blockers. Additive effects occur when used with other drugs that lower intraocular pressure.

Side effects: Beta blockers may contain sulfites, which may cause allergic-type reactions. Rarely, use may worsen or cause symptoms similarly observed with orally administered beta blockers, such as heart disturbances (abnormal heart rhythm, heart attack, or heart failure), asthma, chronic obstructive pulmonary disease, impotence, or mental changes (especially in elderly persons).

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