Do Not give topical analgesics to the patient as this can lead to painless ocular perforation. Combined with topical anaesthetic this agent is useful for tonometry and for staining epithelial defects, eg. herpetic dendrites and corneal abrasions. Fluorscein papers are much cheaper than the minims. It must be given 4 times a day and can cause some stinging and a headache initially. Patients may also note some decrease in vision secondary to the miosis.
Overuse can lead to systemic toxic effects.
Timolol is a beta blocker and as such topical administration consistently reduces heart rate and shares with systemic beta blockers the ability to worsen congestive heart failure. Caution must be exercised in use with patients with a history of syncope, bradyarrythmias, heart block, fibrillation or infarction. Bronchospasm and exacerbation of asthma has been well documented after the use of timolol. Pulmonary function tests have been shown to worsen after only one drop . Patients often experience paresthesias of their hands and face.