Topical timolol in the treatment of monocular oscillopsia secondary to superior oblique myokymia: a review

Abstract

Some reports have outlined many different treatment strategies for superior oblique myokymia (SOM) that attempt to reduce or eliminate patients’ symptoms of monocular oscillopsia and/or diplopia. Most treatment strategies have focused solely on oral medications or invasive surgery. The following is a current and critical review of SOM along with its clinical findings/symptoms, demographics, theories of its pathogenesis, management/treatment options, new observations in SOM, as well as a case report to highlight a relatively novel idea for the treatment of SOM: topical timolol eye drops. It also highlights evidence of a new “localized theory” regarding topical β-blockers’ mechanism of action in SOM compared to the previous systemic hypothesis proposed in 1994.The case report shows a 29-year-old female patient who suffered with SOM symptoms for 8–10 years and then experienced a worsening of her symptoms shortly postpartum. The patient was prescribed topical timolol eye drops by the author in the affected eye based on one case report12 from 1994, which completely eliminated her symptoms within 1–2 days of starting the treatment with any recurrence with the daily use of the drop at the time of this article. Given the robust effect in this case, topical timolol may be a potentially useful drug in the management of SOM given its affordability and safer side effect profile in comparison to the oral medications traditionally used in SOM.