The possible side-effects of topical beta-blockers are not just limited to the eye; they can be systemic as well. For this reason, it is even more important for the patient to read the patient information leaflet that comes with the drug before first using it and then to keep it safe for future reference.
Certainly, changes in health, physical or mental, should be reported to the prescriber and the possibility of systemic side-effects kept in mind. There have been reports of ocular discomfort with the use of beta-blockers, such as sensations of burning, signs of hyperaemia, toxic keratopathy, punctate keratopathy, periocular contact dermatitis and dry eye. (3)
As we have discussed previously in this series, it is possible that the presence of preservatives in an eye drop can lead to ocular toxicity, especially if the patient could be using the drops for years, if not decades.
With this in mind, new forms of Timolol have been developed in preservative-free gel form, such as Tiopex (Figure 1).
Figure 1: Tiopex eye gel (courtesy of Thea Pharmaceuticals)