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Intraocular Beta Blocker

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Intraocular Beta Blocker, Beta Blocker Glaucoma Preparation, Intraocular Betaxolol, Betoptic, Levobunolol, Betagan, Metipranolol, OptiPranolol, Intraocular Timolol, Timoptic, Timoptic XE

  • Indications
  1. Open Angle Glaucoma first line agent
  • Contraindications
  • Relative (related to systemic absorption risk described below)
  1. Asthma
  2. Chronic Obstructive Pulmonary Disease
  3. Congestive Heart Failure
  4. Cardiac conduction disturbance
  5. Depression
  6. Concurrent systemic Beta Blocker use
  • Mechanism
  1. Decreases formation of Aqueous Humor (lowers IOP 20-25%)
  2. Does not interfere with Vision
  • Medications (Yellow Caps)
  1. Betaxolol (Betoptic): $39
    1. Only selective Beta Blocker eye drop (may be used in COPD, Asthma)
    2. Concentrations: 0.25%, 0.5%
    3. Dose: 1 gtt bid
  2. Levobunolol (Betagan): $29-34
    1. Concentrations: 0.25%, 0.5%
    2. Dose: 1 gtt qd-bid
  3. Metipranolol (OptiPranolol): $24
    1. Concentrations: 0.3%
    2. Dose: 1 gtt bid
  4. Timolol (Timoptic): $30-35
    1. Concentrations: 0.25%, 0.5%
    2. Dose: 1 gtt bid
  5. Timoptic XE: $17-21
    1. Concentration: 0.25%, 0.5%
    2. Dose: 1 gtt qd
  • Technique
  • Instillation
  1. See Don't Open Eyes Technique for Eye Drop Instillation
    1. Reduces systemic absorbtion
  • Adverse effects
  1. Generally well tolerated
  2. Corneal hypesthesia (decreased Sensation)
  3. Burning or stinging
  4. Systemically absorbed (e.g. Timolol 0.5% one drop each eye is equivalent to Timolol 10 mg orally daily)
    1. Systemic cardiopulmonary effects may occur (Bradycardia, AV Block, CHF exacerbation)
    2. Fatal bronchospasm has occurred (avoid in Asthma and COPD, except Betaxolol which is selective)
  • Reference
  1. (1995) Med Lett Drugs Ther 37:(956):76-77 [PubMed]
  2. Harris (2023) Am Fam Physician 107(3): 238-46 [PubMed]