Side effects inherent to systemic beta-blockers make propranolol contraindicated in patients with certain cardiac and pulmonary conditions. Due to systemic absorption, topical beta-blockers such as timolol maleate, which are used as anti-glaucoma agents, have similar contraindications. The follow report describes an ocular hypertensive patient who was switched from timolol maleate to latanoprost because of a newly diagnosed possibility of mild COPD. The patient developed a bilateral hand tremor, which was previously blocked by systemic absorption of the topical beta-blocker. Included are classification, differential diagnosis and treatment of essential tremor, as well as a review of the mechanism of action and contraindications of timolol maleate and latanoprost.
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