Thymoxamine hydrochloride: an alpha-adrenergic blocker

Thymoxamine is an alpha-adrenergic blocking agent which works by competitive antagonism of norepinephrine. It is the only alpha-adrenergic blocker available which has tolerable side effects when used as an ophthalmic solution. When used as a 0.5% solution it consistently produces miosis without affecting the intraocular pressure or the ciliary muscle-controlled facility of outflow. The only regularly reported side-effects at this concentration are transient burning and conjunctival hyperemia. Potential applications of thymoxamine include reversal of phenylephrine mydriasis, treatment of angle-closure glaucoma, treatment of persistent mydriasis after penetrating keratoplasty for keratoconus, reversal of lid retraction in thyroid ophthalmopathy, testing to differentiate angle-closure glaucoma from open-angle glaucoma with narrow angles, aiding in repositioning and maintaining the position of intraocular lenses, treatment of pigmentary glaucoma. Thymoxamine may also contribute to a better understanding of the adrenergic nervous system on aqueous dynamics.