Complete atrioventricular block due to timolol eye drops: a case report and literature review

Abstract

BackgroundTimolol Maleate is a non-selective beta-adrenergic blocker that is commonly used to treat open-angle glaucoma. Despite its topical administration, ophthalmic timolol enters systemic circulation and produces a systemic beta-adrenergic blockade. We report a case of long-term timolol use that uncovered and worsened an underlying cardiac conduction defect demonstrated as a third degree atrioventricular (AV) block.Case presentationA 62-year old male with a 13-year history of glaucoma was hospitalized due to shortness of breath, dizziness, and amaurosis. Electrocardiography indicated a heart rate (HR) of 29 bpm with complete atrioventricular (AV) block, and the HR was significantly increased with the treatment of isoprenaline. However, the patient experienced bradycardic episodes (− 20 Δbpm) immediately after self-administration of timolol eye drops. The AV block and bradycardia resolved 48-h after timolol cessation. The man was discharged 1 week later with an asymptomatic first-degree A-V block. However, he presented with a worsened A-V block at his one-year checkup.ConclusionWe conclude that chronic topical timolol administration may aggravate a cardiac conduction defect leading to an AV block that is only temporarily resolved by timolol cessation. Patients taking timolol should be routinely monitored for cardiovascular aberrations and if any detected, immediately discontinue timolol therapy. Individuals experiencing timolol induced cardiovascular side effects should receive long term follow-up even if symptoms resolve, as they may be indicative of an underlying conduction defect.

Stable Gastric Pentadecapeptide BPC 157 Therapy of Rat Glaucoma

“…Thereby, we would cause less injury in glaucomatous rats, incompletely defined, since contralateral retinas in unilateral models of retinal injury show neuronal degeneration and glial activation as well [ 49 ]. Probably not only in theory, BPC 157 therapy in the form of eye drops, intraperitoneal or per-oral, in drinking water, prophylactic as well as curative, would complement the regular anti-glaucoma therapy options, as well as laser trabeculoplasty, and thereby avoid their possible complications and adverse effects [ 50 , 51 ].…”

Timolol 0.5% ophthalmic solution influences cardiac function in healthy cats

“…Considering that only healthy cats were included, some possible side effects were not observed, such as bronchoconstriction, 52 which is an important reason for contraindication of timolol for cats with feline asthma. 15 This eye solution might also be avoided in elderly cats, as its continued use has been linked to syncope, 53 postprandial head-drops 54 and atrioventricular block 55 in older people. Some studies do not recommend timolol for long-term treatment of glaucoma in cats with cardiac diseases, 15,56 but nothing is known about the effect of a single administration in cats with advanced heart failure.…”

Conflicto terapéutico en pacientes con COVID-19 y glaucoma

“…Su mecanismo de acción consiste en producir una disminución de la presión intraocular al reducir la producción de humor acuoso a nivel de los receptores betaadrenérgicos de los procesos ciliares oculares. Varios estudios han informado sobre los efectos sistémicos conocidos del maleato de timolol tópico como bradicardia, hipotensión, bloqueo aurículo ventricular, empeoramiento de la insuficiencia cardíaca congestiva e inducción de broncoespasmos 2 .…”