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Beta-blocker eye drops

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VOL: 102, ISSUE: 22, PAGE NO: 29

Generic and proprietary names

- Betaxolol: Betoptic.

- Carteolol: Teoptic.

- Levobunolol: levobunolol, Betagan.

- Metipranolol: Minims Metipranolol.

- Timolol: timolol, Nyogel, Timoptol.

Action

- Effective at reducing intra-ocular pressure by reducing the rate of aqueous humour output.

Classification

- Eye. 

- Treatment of glaucoma.

Indications

- Chronic simple glaucoma.

Contraindictions

- Due to possible systemic absorption this medication is contraindicated in patients with bradycardia, heart block or uncontrolled heart failure.

Cautions

- Should not be used in patients with asthma or a history of obstructive airways disease, unless no alternative treatment is available.

Common side-effects

- Ocular stinging.

- Burning.

- Pain.

- Itching.

- Erythema.

- Dry eyes.

- Allergic reactions including anaphylaxis and blepharoconjunctivitis.

Rare side-effects

- Corneal disorders.

Interactions

- Due to the possibility of systemic absorption, interactions should be considered and the BNF consulted.

Administration

- Eye drops.

Nursing considerations

- The preparations have excellent pressure-lowering efficacy, long duration of action and are considered equally effective.

- Preparations for the eye should be sterile when issued.

- Despite the inclusion of preservatives care should be taken to avoid contamination of the eye drops during use.

- Multiple-application containers for domiciliary use should be discarded four weeks after first opening. 

- Eye drops for hospital use are normally discarded one week after first opening.

- Individual containers should be provided for each patient but a separate bottle need only be supplied for each eye if there are special concerns about contamination.

- Containers used before an operation should be discarded at the time of the operation and fresh containers supplied.

Patient teaching

- Patients should be advised on the correct application of their drops. This normally involves instilling the drops into the pocket formed by gently pulling down the lower eyelid and keeping the eye closed for as long as possible after application.

- Eye-drop dispenser devices are available for patients who need help with the instillation of eye drops from plastic bottles.

- Patients who wear contact lenses should check whether their lenses are compatible with the formulation of the eye drops as some preservatives may accumulate in some lenses such as hydrogel lenses and induce toxic reactions.

Nurses should refer to manufacturer’s summary of product characteristics and to appropriate local guidelines.

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