Sir,

I read with interest Yassif and coworkers' description of a challenging case of panuveitis responding to oral metoprolol therapy.1 This is indeed a finding that deserves further investigation to elucidate the mechanisms involved, and clinical implications thereof.

Some early data in this regard have already been published; Er et al2 demonstrated that topical beta blockade using timolol maleate was able to reduce aqueous levels of proinflammatory cytokines interleukin-6, interleukin-8, and tumour necrosis factor-α in a rabbit model of ocular inflammation. In the case described, the patient was commenced on topical timolol in order to treat the secondary glaucoma; however, this had no effect on the inflammatory process. It is possible that that oral metoprolol was effective because it had a higher bioavailability within the posterior segment, as well as anteriorly. It was thus effective in suppressing ocular inflammation through the mechanisms described above.