Studies have shown that systemic absorption of ophthalmic beta-blockers (OBBs) can potentially cause severe systemic side effects. OBJECTIVES: To evaluate the use of OBBs among patients with a contraindication or precaution against its use. METHODS: We conducted a retrospective analysis of pharmacy and medical claims data from a West Coast health plan. Patients receiving a prescription for ophthalmic betaxolol, carteolol, levobunolol, metipranolol, or timolol between 7/1/98 and 6/30/00 were included in this study. Study cohorts were identified based upon the first OBB agent received and were followed for 180 days. Patients receiving prescriptions for different OBBs that were more than 180 days apart were categorized as having two episodes of care. OBBs are contraindicated in patients with sinus bradycardia/persistent severe bradycardia, asthma, COPD, and greater than first degree heart block. OBBs have precautions against use in patients having diabetes mellitus, congestive heart failure, Raynaud's phenomenon, or using oral beta-blockers. OBB use was defined as inappropriate if used simultaneously with oral beta-blockers, within 15 days of heart block diagnosis, or within 6 months of the other conditions. RESULTS: A total of 9,094 unique patients contributed 9,294 episodes of care. The percentage of patients with a contraindication or precaution against OBB use, respectively, was 12.7% and 20.9% (betaxolol: 19.9% with contraindication, 22.7% with precaution; carteolol: 9.7%, 20.9%; levobunolol: 13.0%, 21.5%; metipranolol: 9.2%, 21.5%; timolol: 10.7%, 20.3%). Overall, 29.6% of patients had at least one contraindication or precaution against OBB use, and 7.6% had multiple contraindications and/or precautions. CONCLUSION: Nearly three out of ten patients who received an OBB had a contraindication or precaution against its use. Further research is needed to determine the incidence of clinically significant adverse effects from prescribing OBBs in these patient populations, and to identify alternative glaucoma medications that may be more appropriate for these patients.