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A man in his 60s came to the clinic for the first time with red eyes. His fundus findings raised suspicion of glaucoma, and further tests showed a visual field abnormality, leading to a diagnosis of glaucoma.
Because he was being treated for interstitial pneumonia, we found that we could not use a combination glaucoma eye drop (Mikeluna®).
Timolol-induced interstitial lung disease
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4501462/
Respir Med Case Rep. 2015; 15: 30–32.
(From the paper above) A 76-year-old woman developed cough, difficulty breathing, and hypoxemia after using timolol, an anti-glaucoma eye drop, following glaucoma surgery.
A CT scan led to a diagnosis of interstitial pneumonia (inflammation of the alveoli, the tiny sacs that make up the lungs), and she recovered after timolol was stopped and steroid treatment was given.
Glaucoma eye drops can cause side effects both locally (in the eye) and throughout the body, so I explain them first and prescribe with care.
When starting eye drops, I ask patients to come back for an early follow-up visit.
Compared with when I was a resident, there are many more glaucoma eye drops to choose from and they are much more effective. Side effects have decreased as well, and I have the impression that damage to the cornea (the black of the eye) in particular has become less common.
The goal is to treat and monitor so that no symptoms (narrowing of the visual field, reduced vision, and so on) appear in your lifetime.
Thank you for your understanding.
