Metoprolol and eye problems
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Metoprolol and Eye Problems: A Comprehensive Review
Introduction to Metoprolol in Ophthalmology
Metoprolol, a beta-1 selective beta-blocker, is commonly used in the treatment of cardiovascular conditions. However, its application in ophthalmology, particularly for managing intraocular pressure (IOP) in glaucoma and ocular hypertension, has been explored extensively. This article synthesizes the findings from multiple studies on the ocular effects and potential side effects of metoprolol.
Efficacy of Metoprolol in Reducing Intraocular Pressure
Short-term and Long-term Effects on IOP
Several studies have demonstrated that metoprolol effectively reduces IOP in patients with glaucoma and ocular hypertension. A study involving 10 patients treated with 3% metoprolol eye drops twice daily over four months showed a significant reduction in IOP, with an initial mean decrease of 36% and a maintenance decrease ranging between 23% and 30% . Another study comparing metoprolol with pilocarpine found that both drugs lowered IOP by approximately 30% over a four-week period . Additionally, a pilot study reported a reduction in mean IOP from 30.1 to 20.6 mmHg in patients treated with oral metoprolol .
Comparative Efficacy with Timolol
Metoprolol has been compared with timolol, another beta-blocker, in several studies. One study found that timolol had a slightly greater pressure-lowering effect than metoprolol, with a mean reduction of 9% more in IOP . Another study confirmed that both drugs significantly reduced IOP, but timolol was more effective, reducing IOP from 14.8 to 10.7 mmHg compared to metoprolol's reduction from 14.1 to 11.5 mmHg .
Side Effects of Metoprolol in Ophthalmic Use
Local Ocular Side Effects
The most common side effects of metoprolol eye drops are local irritation, including burning, itching, and tearing 12. In a study involving 36 patients, higher concentrations of metoprolol (above 1%) were associated with increased reports of burning sensations . Additionally, transient epithelial keratopathy and exanthema were observed in a few patients .
Systemic Side Effects
While metoprolol is primarily a beta-1 selective blocker, its systemic absorption can potentially affect cardiovascular parameters. However, most studies reported no significant impact on blood pressure or heart rate with topical application 346. One study noted a reduction in heart rate with oral administration of metoprolol, but this effect was not observed with eye drops .
Comparative Safety with Timolol
Both metoprolol and timolol have been associated with dry eye symptoms, as indicated by tests such as break-up time and Schirmer test . However, no significant deterioration in visual fields or visual acuity was reported with either drug .
Conclusion
Metoprolol has been shown to be an effective agent in reducing intraocular pressure in patients with glaucoma and ocular hypertension. While it is generally well-tolerated, local ocular irritation is a common side effect. Comparatively, timolol may offer a slightly greater reduction in IOP but shares similar side effect profiles. Overall, metoprolol remains a viable option for managing IOP, with careful consideration of its side effects and patient tolerance.
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