[Bradyarrhythmia and topical timolol : highlighting the need for medication reconciliation]

Ophthalmic beta-blockers such as timolol can exert clinically significant systemic effects due to high transnasal and conjunctival absorption. We describe a 94-year-old woman who developed symptomatic bradyarrhythmia, including sinus pauses and atrial fibrillation with slow ventricular response, attributed to topical timolol. Symptoms resolved following discontinuation and substitution with non-beta-blocker therapy. This case underscores the importance of comprehensive medication reconciliation, explicitly addressing non-oral routes of administration. In elderly, polymorbid patients, unrecognized topical medications may lead to delayed diagnosis and preventable adverse events. Clinicians should systematically assess all formulations when investigating potential drug-related cardiovascular effects.