Brimonidine-induced Anterior Uveitis and Conjunctivitis

Abstract

Brimonidine tartarate is a selective alpha2-adrenergic receptor agonist that is indicated for use in the treatment of glaucoma and ocular hypertension. Since its introduction in 1997 there have been a small number of case reports concerning granulomatous anterior uveitis as a late adverse reaction to long-term brimonidine therapy. We report a case of bilateral anterior uveitis and granulomatous papillary conjunctivitis in a 78-year-old gentleman after 2 years of brimonidine therapy. Cessation of brimonidine lead to rapid termination of uveitis. The histologic features of the conjunctiva are described. This has not been previously reported.

Comparison of intraocular pressure-lowering effects of ripasudil hydrochloride hydrate for inflammatory and corticosteroid-induced ocular hypertension

“…Previous reports have proposed that adrenergic agonists decrease the volume of conjunctival cells and widen the space between cells, allowing greater access of pro-inflammatory agents and continued topical administration of α2-agonists in eyes with allergic reactions may predispose to the development of uveitis [ 24 ]. Histological findings of conjunctivitis and anterior uveitis induced by α2-agonists have also been reported [ 25 ]. Patients with dark irises may be more susceptible to inflammation because α2-agonists reach a higher concentration in pigmented tissues [ 26 ].…”

Brimonidine Induced Anterior Uveitis

“…[2][3][4][5][6] In addition to conjunctivitis, sporadic case reports have emerged since 2000, of anterior uveitis in patients treated with topical brimonidine tartrate. [7][8][9][10][11][12][13][14][15][16][17] In this paper, we report 19 eyes affected by brimonidine induced uveitis, the largest series reported so far. We present the clinical characteristics of this under-diagnosed and easily treatable condition.…”

Drug-induced Uveitis

“…[43][44][45][46] In those reports the patients developed anterior uveitis after a prolonged use of brimonidine similar to the cases reported by Byles and colleagues. Byles et al 42 reported 4 patients who developed acute granulomatous anterior uveitis 11 to 15 months after using brimonidine 0.2% twice daily.…”