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August 22, 1980

Syncope and Visual Hallucinations, Apparently From Timolol

Author Affiliations

Eye Clinic Inc Terre Haute, Ind

JAMA. 1980;244(8):768-769. doi:10.1001/jama.1980.03310080010007

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To the Editor.—  Stephen A. Shaivitz, MD (242:1611, 1979), recently reported in The Journal on aggravation of myasthenia with timolol maleate. Alan N. Kohn, MD (243:1131, 1980), warned of systemic effects.Timolol, a β-adrenergic receptor blocking agent, has been prescribed to thousands of patients since its recent Food and Drug Administration approval for glaucoma.I treated an alert, active, and unusually healthy 78-year-old woman with timolol starting in November 1978. It controlled her open-angle glaucoma well. Unlike most persons in this age group, she was taking no other medications. On Labor Day 1979, she was swimming in a lake and experienced an episode of syncope and nearly drowned. A hospital workup was noncontributory.On Feb 14, 1980, she experienced confusion, inability to speak or write for a few minutes, and vivid and frightening visual hallucinations for several days. She was hospitalized by an internist. Findings from a complete workup, including computerized