It never happens, until it happens

Abstract

An 86-year-old female patient was treated at home after having suffered a syncopal episode preceded by intermittent dyspnea in the previous weeks. Upon admission, the electrocardiogram showed Mobitz 2 second-degree AV (atrioventricular) block. Our patient suffered from systemic hypertension and chronic open-angle glaucoma, treated, respectively, with losartan 100 mg/hydrochlorthiazise 25 mg every 24 h and timolol 0.5% two times a day (introduced three weeks before after being assessed by ophthalmology service at another hospital center). Dyspnea and electrocardiographic blockage signs stopped once ocular beta blockers (timolol) were discontinued. Ocular topical administration is usually the preferred route for drug supply in ophthalmology and especially in glaucoma treatment, but it is not devoid of interactions and adverse effects. The following clinical case describes how the use of topical beta blockers for the treatment of glaucoma may be at the origin of systemic beta-blockade in our patient, a not so common, yet described situation.