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Superior Oblique Myokymia (SOM) is a rare eye condition characterized by episodic oscillopsia and diplopia. The etiology remains unclear, and treatment options historically included surgery and systemic drugs. More recently, topical treatment such as Timolol have emerged as effective therapeutic option though the role of Brinzolamide for SOM has not been described in literature.This retrospective case series reviewed the outcomes of five SOM patients treated with topical therapies (Timolol 0.5% and Brinzolamide) at a single centre over a three-year period. Patients were assessed for symptom resolution and side effects following treatment.Of the five patients, four were treated with off-label Timolol. Two achieved complete symptom resolution within eight weeks and remained symptom-free at 12-month follow-up. Two patients who did not respond to Timolol were transitioned to Brinzolamide and showed excellent response. One patient with asthma and bronchiectasis was treated with Brinzolamide as the primary therapy and also experienced symptom relief. No significant side effects were reported in the cohort.Timolol 0.5% is effective as a first-line treatment for SOM, providing relief for many patients. For those unresponsive to Timolol or with contraindications, Brinzolamide offers an equally effective alternative, broadening treatment options for this rare condition.