Side Effects of Topical Ophthalmic Beta-Blockers: Association with Alopecia

March 1990 in “ JAMA ”

J. G. Wingfield

alopecia topical ophthalmic β-blockers timolol betaxolol levobunolol diffuse alopecia non-scarring alopecia scalp alopecia eyelash alopecia eyebrow alopecia alopecia areata hair loss topical eye β-blockers

TLDR Eye drops with β-blockers may cause hair loss.

The document reports on the side effects of topical ophthalmic β-blockers, specifically their association with alopecia. The National Registry of Drug-Induced Ocular Side Effects received 56 cases of alopecia in patients using topical ocular timolol (48 patients), betaxolol (5 patients), or levobunolol (3 patients), with ages ranging from 33 to 86 years and over 90% being female. The alopecia was diffuse, non-scarring, and affected the scalp, eyelashes, and/or eyebrows, with 4 cases reported as alopecia areata. The duration of therapy before alopecia ranged from 1 to 24 months, and recovery usually occurred within 4 to 8 months after discontinuing the drug. The document suggests that physicians should consider topical ophthalmic β-blockers as a potential cause of alopecia when evaluating patients. Further studies are needed to verify this hypothesis through challenge studies after hair regrowth.