Alopecia Possibly Secondary to Topical Ophthalmic β-Blockers

To the Editor.—  Topical ophthalmic β-blockers are the most commonly used treatment for glaucoma. There are three topical ophthalmic β-blockers available: betaxolol, levobunolol, and timolol. Two of these were among the top 200 most commonly used prescription drugs in 1988. Although these β-adrenergic blocking agents are well tolerated by the majority of patients, side effects account for therapy discontinuance in up to 10% of patients.¹ Side effects caused by systemic β-blockers also have been reported secondary to use of topical ophthalmic β-blockers, since therapeutic levels of plasma timolol have been observed 1 hour after receiving topical ophthalmic timolol.^2,3 Alopecia has been reported in patients who use oral β-blockers.^4-8 This is the first report of alopecia due to use of topical ophthalmic β-blockers.The National Registry of Drug-Induced Ocular Side Effects (Department of Ophthalmology, Oregon Health Sciences University, Portland) has received reports of 56 cases of alopecia in