We report on two cases of granulomatous conjunctivitis and uveitis related with the use of a brimonidine-timolol fixed combination. Case report and a review of medical literature. A 64-year-old man was diagnosed with marked granulomatous uveitis and a 57-year-old woman was diagnosed with granulomatous conjunctivitis. Both patients were using a topical fixed combination of brimonidine 0.2 %-timolol 0.5 % for open angle glaucoma. Bilateral granulomatous uveitis and conjunctivitis were diagnosed after 16 months of treatment with a fixed combination of brimonidine-timolol in both cases. Granulomatous inflammation resolved with the cessation of antiglaucomatous drugs and topical corticosteroid treatment. When the inflammation had resolved completely, both patients were rechallenged with topical brimonidine in one eye only to determine causality. Conjunctival hyperemia is a common side effect of glaucoma medications and is sometimes overlooked. Hyperemia may be associated with other signs such as iritis and keratic precipitates or conjunctival inflammation. In such cases, granulomatous inflammation may be considered in the differential diagnosis. The fixed-combination of brimonidine-timolol may cause this clinical picture.

Patient: Female, 27Final Diagnosis: Vogt Koyanagi Harada DiseaseSymptoms: Headache • vision lossMedication: —Clinical Procedure: —Specialty: OphthalmologyObjective:Unusual clinical courseBackground:The aim of this study was to describe the case of a 27-year-old woman who developed Vogt-Koyanagi-Harada (VKH) disease in the 13th week of pregnancy, who was treated with high-dose oral corticosteroids and azathioprine due to its persistent course.Case Report:A 27-year-old East Indian woman in her 13th week of pregnancy presented with bilateral decreased visual acuity and metamorphopsia due to bilateral serous retinal detachments and was diagnosed with Vogt-Koyanagi-Harada (VKH) disease. Multimodal imaging, including blue light fundus autofluorescence (FAF), structural spectral domain optical coherence tomography (SD-OCT), en-face OCT, and OCT angiography (OCT-A), was performed at presentation and follow-up, being particularly helpful for identifying recurrences. Her treatment consisted of high-dose corticosteroid therapy, and azathioprine had to be added as an adjuvant due to the aggressive behavior of the disease. She gave birth to a healthy baby at 31 weeks of gestation and remained with 20/20 vision at 8 weeks postpartum.Conclusions:To the best of our knowledge, this is the first report on the use of azathioprine in VKH disease during pregnancy with a successful outcome. Multimodal imaging avoiding the use of fundus fluorescein angiography is key in the diagnosis and follow-up of VKH disease in pregnant women.

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