A patient on long-term topical timolol 0.5% twice daily for glaucoma develops worsening dyspnea and bradycardia. The most appropriate alternative anti-glaucoma agent with a similar mechanism but reduced systemic absorption would be:

• A Betaxolol (a selective beta-1 blocker with minimal beta-2 effect on bronchi) ✓
• B Carteolol (a non-selective beta-blocker with intrinsic sympathomimetic activity)
• C Levobunolol (a non-selective beta-blocker)
• D Brimonidine (an alpha-2 agonist)

Explanation

Betaxolol is a cardioselective (beta-1 selective) beta-blocker used topically for glaucoma. Its selectivity for beta-1 receptors reduces the bronchospastic risk associated with non-selective beta-blockers like timolol, levobunolol, and carteolol. Betaxolol is therefore preferred in patients with reactive airway disease or COPD. Brimonidine is an alternative from a different class but addresses a different mechanism.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.