title: Ganfort, a blinding drug to the physician.
abstract: 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.
authors.affiliation: Guy's & St Thomas' NHS Foundation Trust, London, UK.
authors.forename: Lennard
authors.initials: L
authors.lastname: lee
authors.forename: Chris
authors.initials: C
authors.lastname: Turnbull
authors.forename: Mohammed Majid
authors.initials: MM
authors.lastname: Akhtar
authors.forename: James
authors.initials: J
authors.lastname: Fleet
mesh_terms: D000577:Amides / Q000009:adverse effects*; D000925:Anticoagulants / Q000627:therapeutic use; D003008:Cloprostenol / Q000009:adverse effects / Q000031:analogs & derivatives*; D004338:Drug Combinations; D004417:Dyspnea / Q000209:etiology; D005902:Glaucoma, Open-Angle / Q000188:drug therapy; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions / Q000009:adverse effects*; D011655:Pulmonary Embolism / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy; D011859:Radiography; D013610:Tachycardia / Q000175:diagnosis* / Q000209:etiology; D013999:Timolol / Q000009:adverse effects*
chemical_list: D000577:Amides; D000925:Anticoagulants; D004338:Drug Combinations; C571755:Ganfort; D009883:Ophthalmic Solutions; D003008:Cloprostenol; D013999:Timolol