OBJECTIVE: To determine the frequency of congestive heart failure and cardiac conduction disturbances in elderly patients treated with topical glaucoma medications. METHODS: These case-control studies were conducted among participants in the New Jersey Medicaid and Medicare program from 1986 to 1990. A total of 35,445 subjects (ages 65 to 99 years) were included in the congestive heart failure analysis, and 4278 subjects were included in the conduction disorder analysis. RESULTS: The frequency of initiation of congestive heart failure therapy, defined as the new use of digoxin or furosemide, was not increased for users of topical glaucoma medications. The frequency of pacemaker placement was also not increased for topical glaucoma medication users. Analyses were adjusted for age, race, gender, nursing home or hospital status, number of prescription medications, and selected medication exposures. Advanced age and heavy use of other prescription medications were associated with an increased likelihood of both cardiovascular outcomes. CONCLUSION: Major cardiovascular side effects did not occur at an increased rate among patients using topical beta-blockers or other glaucoma medications compared with control subjects. This population-based study places findings from case reports and small clinical trials in a broader context to help with clinical assessment of the risks and benefits of glaucoma therapy in the elderly.