Letter to the Editor

Topical Beta Blockers and Essential Tremors: a case report^*

IK Jalili¹, S Sen², McVicar S³

¹ Consultant Ophthalmologist, Warrington Hospital Trust

² SHO in Ophthalmology, Warrington Hospital Trust

³ General Practitioner, Beaumaris, Anglesey, North Wales

An 83-year old lady was referred to us by her optician. On examination, she was diagnosed to have bilateral open angle glaucoma. She as otherwise generally lit except tor the fact that she suffered from senile essential tremors. This was so severe that it interfered with uh her daily activities so much so she had to use a straw to drink from a cup or tumbler. She was stated on Levobunolol 0.5% for her glaucoma.

On review two months later her glaucoma was well controlled. However, one remarkabke side effect of the topical Levobunolol was that her essential tremors had resolved almost completely. She could now hold a cup of coffee and sign her name as well as pursue other daily act activities quite comfortably.

While systemic beta blockers (Propranolol 40 mg two to three times a day) have been recommended for the treatment of severe essential tremors this is the first instance to the best of’ our knowledge where a topical beta blockers (two drops of 0.5% Levobunolol twice daily) has succeeded in ameliorating the symptoms of this distressing condition. This case suggests that perhaps much lower doses than those currently recommended of systemic beta blockers could be equally effective in this condition. This would serve to reduce many of the side-effects such as headaches, gastro-intestinal and sleep disturbances of this group of drugs.

References:

Rjchardson EP, Adams RD. Degenerative diseases of’ the Nervous system. In: Harrison’s Principles of Internal Medicine. 10th ed. McGraw Hill, 1983, pp 2129.