A patient on long-term topical timolol maleate 0.5% develops bradycardia and bronchospasm. Which class of anti-glaucoma drug should be avoided in patients with reactive airway disease, and which is the safest alternative from the same first-line category?

• A Avoid prostaglandin analogues; use CAIs instead
• B Avoid alpha-2 agonists; use topical CAIs instead
• C Avoid miotics; use beta-blockers instead
• D Avoid beta-blockers; use a prostaglandin analogue instead ✓

Explanation

Non-selective beta-blockers like timolol block bronchial β2 receptors and are contraindicated in asthma, COPD, and reactive airway disease. They also cause systemic bradycardia via β1 blockade. Prostaglandin analogues (latanoprost, bimatoprost, travoprost) are the most potent IOP-lowering class, act via increased uveoscleral outflow, and have no systemic contraindications in airway disease, making them the safest first-line alternative.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.