Periocular cutaneous pigmentary changes associated with topical betaxolol

We report two cases of periocular cutaneous hypopigmentation and one case of hyperpigmentation which appeared while the patients were on betaxolol. We propose several possible explanations for this phenomenon.

Charts of three patients with glaucoma who developed periocular cutaneous pigmentary changes while on betaxolol were reviewed retrospectively.

Case #1 was a 47-year-old black man with primary open angle glaucoma, started on betaxolol 0.5% in both eyes in January 1981. Bilateral hypopigmentation of the eyelids was first documented in October 1987. Betaxolol was discontinued in November 1987. In December 1990 the pigmentation had returned to normal. Case #2 was a 4-month-old white boy with unilateral primary infantile glaucoma who was started in September 1992 on betaxolol 0.25% in the left eye. Left lower eyelid hypopigmentation was seen in April 1993. Betaxolol was discontinued in July 1993. Since that time the pigmentation has returned to normal. Case #3 was a 75-year-old black man with primary open angle glaucoma. He was placed on betaxolol 0.5% in both eyes in 1987 and in March 1988 hyperpigmentation of the eyelids was seen bilaterally. Betaxolol was discontinued, and by December 1990 the pigmentation had returned to normal.

These three case histories suggest that the periocular cutaneous changes described herein are secondary to local instillation of betaxolol.