SUBLINGUAL TIMOLOL - AN ALTERNATIVE TO TOPICAL MEDICATION IN GLAUCOMA

Aims-To assess whether timolol drops lower a raised intraocular pressu re (IOP) when given sublingually, This route of administration would b e useful for glaucoma patients who are unable to instil their own drop s-for example, because of stroke, poor vision, arthritis, poor coordin ation, or blepharospasm. Methods-A placebo controlled randomised, doub le masked, crossover study was undertaken in the glaucoma clinic of a large teaching hospital. Twelve patients with ocular hypertension with IOPs over 21 nun Hg, normal optic discs, and full visual fields were examined by Humphrey perimetry. Single dose units of timolol maleate 0 .5% drops and normal saline drags were given by instillation in one ey e or sublingually. The IOP of both eyes,pulse Fate, and blood pressure were all measured before and after each type of drop and route of adm inistration. Results-Two hours after instillation of timolol in one ey e, the IOP in the treated eye was reduced by a mean of 8.5 mm Hg (p=0. 0000), and by 1.66 mm Hg in the fellow eye (p=0.03). Two hours after s ublingual instillation of timolol, the IOP was reduced by 7.55 mm Hg i n the study eye (p=0.0000) and by 7.7 mm Bg in the fellow eye (p=0.000 0), There was an equal amount of reduction in pulse rate by either rou te, but there was no significant change in blood pressure. Conclusions -The results show that, at least after 2 hours, sublingual treatment i s almost as effective as topical treatment in lowering a raised IOP.