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Tip of the month
In a patient with glaucoma who has unexplained hair loss, stop topical beta-blocker treatment

Publishing date: May 2017

Tip Editors: John Salmon and Gordana Sunaric Mégevand
Tip reviewer: Roger Hitchings

The Science behind the Tip

Beta adrenergic receptor blocking eye drops are often used to reduce the intraocular pressure. Because of absorption through the nasal mucosa, systemic beta-blockade may occur, leading to side effects that include bradycardia, hypotension and bronchospasm. Less commonly, sleep disorders, hallucinations, confusion, depression, fatigue, dizziness and decreased libido can follow treatment (1, 2).

Alopecia is a rare, pharmacologically unpredictable adverse reaction to topical beta-blockers and can occur at any age.  This has been reported secondary to the use of timolol, betaxolol and levobunolol (3). Hair loss starts from 1 to 24 months after commencing treatment, but hair growth normally returns to normal 4-8 months after stopping the beta-blocker (3). The cause of this side effect is not known.

Contributor: J F Salmon MD Consultant Ophthalmologist - Oxford Eye Hospital (UK)


1) Lewis RV, Lofthouse C  Adverse reactions with beta-adrenoceptor blocking drugs.  Drug Saf 1993: 9: 272-9.

2) Lydtin H. Side effects and contraindications of beta-receptor blocking agents.  Klin Wochenschr 1977 1:55: 415-22.

3) Fraunfelder FT Meyer SM Menacker SJ Alopecia possibly secondary to topical ophthalmic beta-blockers.  JAMA 1990, 16; 263: 1493-94