Eye Drops: Systemic Side-Effects

The use of timolol eye drops in people with glaucoma is the leading risk factor for falling. PB had her timolol changed to another drug and her balance improved within 3 days and she stopped using a walker after 7 days.

Adverse Medication Events: The significance of eye drops causing side-effects in older adults

Adverse drug events (ADE’s), also called side-effects, are responsible for 2.2 million hospital visits and 106,000 deaths each year! If ADE’s were a disease by itself, it would be the 5^th leading cause of death by disease. This becomes more likely as we age since we are more sensitive to the effects of most medications and we tend to take more medications.

The most recent information we have is in relation to systemic side-effects from eye drops. One might assume that the effects of a topically applied eye drop would be limited to the area of the eye. However, the transit of medication through the tear duct into the body make many eye medications as potent as an intravenous (injected) dose of medication. Here are a couple ways to put this into perspective:

**One (1) drop of Timolol 0.5% Opthalmic Solution is as strong as one (1) 10 mg oral tablet used for treatment of hypertension or angina.

**The leading risk for falls in patients with glaucoma is the topical administration of (Timoptic) timolol eye drops.

Here are some examples of documented side-effects found in the literature:

1)          Bronchospasm and congestive heart failure (Timolol)

2)          Depression (Timolol & other beta blockers)

3)          Low blood pressure (Timolol & Pilocarpine)

4)          Headache or “brow ache” (Pilocarpine)

5)          Urinary frequency (Pilocarpine)

6)          Asthenia (Alphagan) Asthenia is defined as physical weakness and loss of strength

This is only mentioning side-effects from one drug at a time. Many older adults take up to four eye drops at the same time for their glaucoma. That being said, we need to pay closer attention to what’s going on. Here’s what we recommend:

1)   One way to reduce the drug from being absorbed into the body is to follow a particular technique. This procedure is called the “double DOT” procedure” which stands for “Don’t open eyes technique and Digital Occlusion of the Tear Duct” This involves closing the eye and applying pressure over the lacrimal duct (tear duct) for 1-2 minutes after application of the eye drop. This technique reduces systemic absorption by two-thirds.

2)   Describe what you might think are side-effects from the list mentioned above.

3)   Report those to the prescriber of those medications and/or consult your pharmacist. You may also consult Elder Drugs if you have concerns relating to your eye drops.