Brimonidine-associated uveitis – a descriptive case series

Abstract

Background Anterior uveitis secondary to topical brimonidine administration is rare and not well-defined. In glaucoma patients using brimonidine, one must consider this phenomenon to avoid mis-diagnosis and over-treatment with topical steroids which in turn may increase intraocular pressure (IOP). This is the largest case series including the longest patient follow-up in the current literature. Methods Sixteen patients (26 eyes) with consultant diagnosed brimonidine-associated anterior uveitis in a tertiary referral glaucoma clinic presenting between 2015 and 2019 were included in this retrospective case series. Clinical records were taken for descriptive analysis. Main outcome measures were the key clinical features, and disease course (therapy, IOP control, patient outcome). Results Key features were conjunctival ciliary injection and mutton fat keratic precipitation in all eyes. The findings were bilateral in 10 patients. Time between initiation of brimonidine treatment and presentation was 1 week to 49 months. Glaucoma sub-types were mostly pseudo-exfoliative and primary open angle glaucoma. Brimonidine treatment was stopped immediately. Additionally, topical corticosteroids were prescribed in 18 eyes and tapered down during the following 4 weeks. Thirteen eyes did not need surgical or laser treatment (median follow-up time 15 months). No patient showed recurrence of inflammation after cessation of brimonidine. Conclusions This type of anterior uveitis is an uncommon but important manifestation which should always be considered in glaucoma patients on brimonidine treatment. Although treatable at its root cause, problems may persist, especially with respect to IOP control. The latter may necessitate glaucoma surgery after the resolved episode of the uveitis.

Topical Medication Therapy for Glaucoma and Ocular Hypertension

“…Brimonidine tartrate reduces AH production and increases the flow in TM and uveoscleral pathways ( Nocentini and Supuran, 2019 ; Cimolai, 2020 ). Brimonidine tartrate (Alphagan ® ) is often administered as second line therapy or combined with other topical medications for the topical treatment of glaucoma and OHT ( Hopf et al, 2020 ) resulting in an IOP reduction of 20–27% ( Nocentini and Supuran, 2019 ; Cimolai, 2020 ). Brimonidine also offers a neuroprotective effect ( Zhou et al, 2019 ; Conti et al, 2021 ).…”

Salmon patch-like conjunctival lesion secondary to long-term administration of topical brimonidine: A case report

“…Brimonidine has been reported to be associated with the development of anterior granulomatous uveitis [ 10 ]. Brimonidine-induced uveitis typically presents with corneal endothelial keratic precipitates and anterior chamber cells and flare [ 11 ].…”

Topical Anti-Inflammatory Agents for Non-Infectious Uveitis: Current Treatment and Perspectives

“…[63][64][65] In one of the largest case series of brimonidineassociated anterior uveitis (16 patients and 26 eyes), the key clinical features were conjunctival ciliary injection and mutton fat keratic precipitates. 66 This group of patients had different types of glaucoma, with none of them having a prior diagnosis of uveitis. The time between initiation of brimonidine treatment and presentation varied widely between 1 week to 49 months, with complete resolution of uveitis within 4 weeks of stopping treatment.…”