However, some adverse effects such as bronchospasm, aggravation of congestive heart failure and cardiac conduction disturbances may occur because of systemic absorption. Betaxolol is the only selective topical beta-blocker which demonstrates lower systemic absorption, but it also has a less potent ocular hypotensive effect. Generally, adrenergic agents are not nearly as effective in lowering the IOP as beta-blockers. These agents cannot be used topically because they have poor corneal permeability. Unfortunately, oral CAIs have the potential to cause a rather lengthy list of adverse effects.
Diuresis typically occurs during the first few days of therapy.
Lethargy, depression, transient paresthesias and anorexia have been documented. About six per cent of patients develop kidney stones during the first year of treatment. 5 Systemic acidosis is possible if the patient is taking another diuretic. Occasionally, patients complain of a metallic taste, which is probably due to the inhibition of carbonic anhydrase in the taste buds. These types account for 90-95 per cent of primary cases of glaucoma.