Transient ischemic attacks and amaurosis fugax from timolol

A variety of neurological disturbances may occur in patients receiving ocular administration of timolol. Possible mechanisms include direct effects on neurons of the central nervous system, effects on peripheral vasculature, and cardiac arrhythmias. Interestingly, transient ischemic attacks have not been documented to occur synchronously with timolol-related arrhythmias. We report a case of recurrent dizziness and staggering gait occurring synchronously with timolol related arrhythmias. An attack of amaurosis fugax also occurred. Discontinuing timolol abolished all the symptoms. Pre-existing autonomic dysfunction in our patient may have been an important contributing factor in his symptomatology.