Beta-blockers for glaucoma

Examples

Generic Name	Brand Name
betaxolol hydrochloride	Betoptic
carteolol hydrochloride	Ocupress
levobunolol hydrochloride	AK-Beta, Betagan Liquifilm
metipranolol	OptiPranolol
timolol hemihydrate	Betimol
timolol maleate	Istalol, Timoptic
Timolol maleate and brimonidine tartrate	Combigan
timolol maleate and dorzolamide hydrochloride	Cosopt

These medicines 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 medicine in a certain order. You can use the color 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 humor) 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 medicines. A combination of medicines 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.

Timolol, levobunolol, metipranolol, and carteolol 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 medicines 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).
• Depression.
• Confusion.
• Fatigue, dizziness, and inability to tolerate exercise.
• Reduced sex drive.

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 medicines 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 analog such as latanoprost (Xalatan).

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

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

Author:	Jeannette Curtis	Last Updated: May 23, 2008
Medical Review:	Kathleen Romito, MD - Family Medicine Carol L. Karp, MD - Ophthalmology
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