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Ganfort eye drops are indicated for adult patients with open-angle glaucoma who have poor response to topical β-blockers or prostaglandin analogues. They contain 0.3 mg of bimatoprost (a prostaglandin) and 5 mg of timolol (β-blocker). The authors present a case of a 45-year-old man with glaucoma presenting with shortness of breath. On admission, he had a normal heart rate, pulse oximetry and examination. Despite being of low risk stratification using the Wells score and the Modified Geneva Score for pulmonary emboli, CT pulmonary angiogram scan subsequently showed extensive bilateral multiple large pulmonary emboli. This case demonstrates that the systemic absorption of ocular β blockers is extremely high and it bypasses the first pass metabolism. Therefore, even one drop of Ganfort into each eye once a day was sufficient to disguise the tachycardia of a large pulmonary emboli.

Original publication

DOI

10.1136/bcr.01.2012.5648

Type

Journal article

Journal

BMJ Case Rep

Publication Date

07/09/2012

Volume

2012

Keywords

Amides, Anticoagulants, Cloprostenol, Drug Combinations, Dyspnea, Glaucoma, Open-Angle, Heart Rate, Humans, Male, Middle Aged, Ophthalmic Solutions, Pulmonary Embolism, Radiography, Tachycardia, Timolol