Postprandial Head-drops: Insight into Systemic Effects of Ocular Timolol Preparation in Elderly

Abstract

Timolol is a nonselective beta-adrenergic antagonist with no intrinsic sympathomimetic activity. Conditions like intraocular hypertension (IOH) and primary open angle glaucoma (POAG) warrant the use of a topical ocular preparation of timolol. It works to effectively lower the intraocular pressure (IOP) in patients with glaucoma but due to its unique pharmacodynamics, it also poses some very striking systemic side-effects. These include heart block, arrhythmias, and syncopal episodes. Herein, we present a challenging case of a previously known healthy elderly 67-year-old female, known case of POAG, who presented to the clinic with a very peculiar complaint, i.e. episodes of her head dropping down on to the table multiple times after she was done eating her food. This led to a cascade of diagnostic tests being employed encompassing cardiovascular, endocrinal, neurological, and gastrointestinal systems; all of which came out to be negative. Finally, after a very thorough literature review, it was established that timolol was the true culprit. The cessation of the drug immediately resulted in lasting relief.

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.…”