Brimonidine-induced unilateral ocular lichen planus: a case report

Abstract

This report was written to describe a case of unilateral brimonidine-induced conjunctival lichen planus. Because the ophthalmic examination indicated chronic conjunctivitis or drug-induced pseudopemphigoid, the patient underwent thorough ophthalmic and systemic examinations, as well as conjunctival biopsy and direct immunofluorescence studies. A 71-year-old woman with unilateral left eye findings of chronic conjunctivitis was referred to our Ophthalmology Department. The patient reported that chronic conjunctivitis began shortly after she initiated use of topical brimonidine. Ophthalmic examination revealed foreshortening of the inferior fornix and symblepharon. Conjunctival biopsy revealed submucous lymphocytes and shaggy distribution of fibrinogen on direct immunofluorescence; this was suggestive of ocular lichen planus. No other systemic lesions were found that were consistent with the presentation of lichen planus. A good response was observed to topical cyclosporine treatment. To our knowledge, this may be the first report of unilateral ocular lichen planus without systemic findings. The correlation with the initiation of topical brimonidine suggests that this might be the first case of biopsy-confirmed brimonidine-induced ocular lichen planus.

Corneal perforation associated with isolated ocular lichen planus: a case report

“…1,3,4 Ocular involvement is uncommon, but if left untreated, it may cause irreversible damage to the visual function. 5 Few cases or isolated ocular LP have been described and, due to the absence of skin or mucosal manifestations, diagnosis is challenging. 3,[5][6][7] Conjunctival signs include subepithelial scarring, fornix foreshortening, and symblepharon formation.…”

“…5 Few cases or isolated ocular LP have been described and, due to the absence of skin or mucosal manifestations, diagnosis is challenging. 3,[5][6][7] Conjunctival signs include subepithelial scarring, fornix foreshortening, and symblepharon formation. Other reported ocular manifestations are pruritic violaceous papules in the eyelids, blepharitis, lacrimal duct stenosis, and canalicular obstruction.…”

“…Conversely, IgA, IgG, IgM, and complement deposition in the conjunctival basement membrane on DIF, are distinguishing features in MMP. [4][5][6] Histopathological examination with hematoxylin and eosin staining in ocular LP exhibits epithelial acanthosis, submucous lymphocytes with a band-like distribution, exocytosis of mononuclear cells, and intraepithelial apoptotic cells (Civatte bodies). 3,5 The hindmost was not performed in our patient; however, DIF also renders the definite diagnosis.…”

“…[4][5][6] Histopathological examination with hematoxylin and eosin staining in ocular LP exhibits epithelial acanthosis, submucous lymphocytes with a band-like distribution, exocytosis of mononuclear cells, and intraepithelial apoptotic cells (Civatte bodies). 3,5 The hindmost was not performed in our patient; however, DIF also renders the definite diagnosis. Ocular LP also represents a therapeutic challenge.…”

“…1 In our case, the sole presence of subepithelial fibrosis and corneal perforation, in the absence of skin or other mucosal lesions, made the diagnosis clinically indistinguishable from other cicatricial conjunctivitis, such as MMP, rosacea, and Stevens–Johnson syndrome (SjS). 5 Recurrent hordeolum and chalazion, lid margin telangiectasia, and erythema are common findings in ocular rosacea. 2 On the other hand, acute sloughing of the entire ocular surface with eyelash loss and symblepharon formation, along with a recent history of systemic drug use, mainly anticonvulsants or antibiotics, are the hallmark of ocular SjS.…”