A patient with POAG is well-controlled on a prostaglandin analogue but has had progressive disc cupping. It is decided to add a second agent. He has asthma and is on salbutamol. The MOST contraindicated class is:
- A Alpha-2 adrenergic agonist (brimonidine 0.2%)
- B Topical carbonic anhydrase inhibitor (brinzolamide 1%)
- C Topical beta-blocker (timolol 0.5%) ✓
- D Rho kinase inhibitor (netarsudil 0.02%)
Correct answer: C. Topical beta-blocker (timolol 0.5%)
Explanation
Non-selective beta-blockers such as timolol are absolutely contraindicated in bronchial asthma and reactive airway disease because beta-2 receptor blockade in bronchial smooth muscle causes bronchoconstriction, potentially precipitating life-threatening bronchospasm. Even topical ocular timolol achieves systemic absorption sufficient to cause bronchospasm. Brimonidine, brinzolamide, and netarsudil do not have significant bronchospastic effects and can be used safely in asthmatic patients.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
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