Beta blockers have a role as a first line treatment in certain categories of patients with ocular hypertension, and also as second line and additional therapy in patients with chronic open-angle glaucoma (COAG).

They should be avoided in patients receiving verapamil and in those with bradycardia, heart block, uncontrolled heart failure, asthma or obstructive airways disease.

Timolol is the beta blocker of choice. It is available in a range of formulations as shown which may suit the circumstances of particular patients. Other beta blockers have not been found to offer worthwhile benefits.

Caution: Ocular irritation, burning, itching and pain, decreased corneal sensitivity, diplopia and ptosis. Systemic absorption occurs and therefore beta-blocker eye drops are contra-indicated in patients with bradycardia, heart block or uncontrolled heart failure.

CSM Warning: The CSM has advised that beta-blockers, even those with apparent cardio selectivity, should not be used in patients with asthma or a history of obstructive airways disease, unless no alternative treatment is available. In such cases the risk of increasing bronchospasm should be appreciated and appropriate precautions taken.

For drug interactions see BNF.

Timolol

• Eye drops 0.25% (£3.33 = 5ml)
• Eye drops preservative-free 2.5mg/ml (£8.45 = 5ml)
• Eye gel 0.25% (long acting) (£3.12 = 2.5ml)

Dose

• Standard preparations: apply twice a day
• Long acting preparations: apply once daily

Betaxolol

• Eye drops: 0.5% (£1.90 = 5ml)

Dose

• Apply twice a day