A glaucoma patient on long-term topical timolol 0.5% presents with worsening breathlessness. She has a history of mild asthma. The MOST appropriate pharmacological substitute to lower IOP while avoiding pulmonary side effects is:

• A Levobunolol 0.5% eye drops
• B Carteolol 1% eye drops
• C Metipranolol 0.1% eye drops
• D Betaxolol 0.5% eye drops ✓

Explanation

Betaxolol is a cardioselective (β1-selective) beta-blocker that has significantly less bronchoconstriction risk compared to non-selective agents like timolol, levobunolol, carteolol, and metipranolol. In patients with mild asthma where a beta-blocker is still needed for IOP control, betaxolol is the preferred option. However, it is still relatively contraindicated in severe asthma or COPD. Levobunolol, carteolol (non-selective with ISA), and metipranolol are all non-selective and carry similar pulmonary risk to timolol.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.