Beta-blockers for glaucoma

Examples

Generic Name	Brand Name
betaxolol hydrochloride	Betoptic
dorzolamide hydrochloride and timolol maleate	Cosopt
levobunolol hydrochloride	ProBeta, Betagan Ophthalmic Solution
timolol maleate	Timoptic

These medications are given in eyedrop form. Beta-blocker eyedrops have yellow or blue bottle caps. If you need to use more than one type of eyedrop, you may need to take each medication in a certain order. You can use the colour of the bottle cap to help you remember when to use each type of eyedrop.

If you are using more than one type of eyedrop, wait 5 minutes between the different eyedrop medicines.

How It Works

Beta-blockers lower the pressure inside the eye by reducing how much fluid (aqueous humour) is produced in the eye.

Why It Is Used

Beta-blockers are most often used to treat open-angle glaucoma. They may be used alone or combined with other glaucoma medications. A combination of medications can help control how much fluid is made in the eye and can also increase the amount of fluid that drains out of the eye.

Levobunolol and timolol must be used with caution in people with glaucoma who also have asthma, chronic obstructive pulmonary disease (COPD), or heart rhythm problems.

How Well It Works

Reducing pressure in the eyes helps slow optic nerve damage, decreasing the rate of vision loss.

These medications may continue to lower pressure in the eyes over several weeks before a stable level is reached.

Beta-blockers may be more effective than pilocarpine or epinephrine alone.

Side Effects

Side effects of beta-blockers include:

• Stinging, aching, or redness in the eyes after using drops.
• Dry eyes and foreign body sensation (the feeling that something is in your eye).
• Slow heartbeat.
• Spasms of the tubes leading to the lungs (bronchospasm or asthma).
• Heart failure due to the buildup of fluid (congestive heart failure).
• Depression.
• Confusion.
• Fatigue, dizziness, and inability to tolerate exercise.
• Reduced sex drive.

Studies have shown that long-term treatment (more than one year) with beta-blocker medications may cause problems with the conjunctiva, the mucous membrane that lines the inner surface of the eyelids and part of the front covering of the eyeball.¹

There is a potential for adverse interactions between beta-blocker medications and other medications. These include calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, diuretics, cardiac glycosides, thyroid supplements, hypoglycemic agents, non-steroidal anti-inflammatory drugs (NSAIDs), and hormones for hormone replacement therapy. This is an especially important consideration for older people who are being treated for glaucoma, because they often also are taking medications for other health conditions.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Beta-blockers are often used to treat open-angle glaucoma because they are effective and usually well-tolerated. Most beta-blockers need to be taken twice a day but some can be taken only once a day. Beta-blockers have many potential side effects. They are more likely to cause side effects in older people and in people with severe lung or heart problems.

Beta-blockers do not affect pupil size or focusing that is needed to read printed material at close range. Some other medications used to treat glaucoma (cholinergics, like pilocarpine) do affect pupil size.

Beta-blockers are often used in combination with a cholinergic, a carbonic anhydrase inhibitor, newer adrenergic agents such as brimonidine (Alphagan), or a prostaglandin analogue such as latanoprost (Xalatan).

Betaxolol is less effective than timolol in reducing pressure in the eyes. However, it is safe for people who have mild chronic obstructive pulmonary disease (COPD) and asthma.

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Author:	Carrie Henley Robin Parks, MS	Last Updated: August 31, 2006
Medical Review:	Adam Husney, MD - Family Medicine Tom Bailey, MD - Family Medicine Carol L. Karp, MD - Ophthalmology
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