Which medication for glaucoma should be avoided in patients with heart block?

Topical beta-blockers are commonly used in the management of glaucoma to reduce intraocular pressure. However, these medications can have systemic effects, particularly on the cardiovascular system. Patients with pre-existing cardiac conditions, such as heart block, may experience exacerbation of their condition if topical beta-blockers are used, as these medications can decrease heart rate and potentially worsen conduction abnormalities.

In patients with heart block, the use of medications that affect heart rate and conduction can lead to significant complications, including further worsening of the block, bradycardia, or even cardiac arrest. Therefore, it is crucial to avoid topical beta-blockers in these patients to prevent potential adverse cardiovascular events.

In contrast, other classes of glaucoma medications, such as topical prostaglandins and topical carbonic anhydrase inhibitors, do not have similar cardiovascular effects and can be safely used in patients with heart block. Systemic beta-blockers also pose risks due to their systemic effects on the heart, but topical formulations should also be approached with caution in this patient population.