Brimonidine is a well established selective alpha-2 adreno-receptor agonist, used to lower intraocular pressure. This case series reports on 19 eyes affected by brimonidine induced uveitis. Mean age of the patients was 74 years and mean duration of brimonidine use was 19.7 months. Seventeen eyes (89%) had been on brimonidine only, while two were on a brimonidine / timolol combination drop. Sixteen eyes were pseudophakic and no eyes had any history of glaucoma surgery. Nine eyes were asymptomatic, while the remaining 10 had symptoms of conjunctivitis (red, irritated and watery). Sixteen eyes had stellate keratic precipitates (KPs) while three had small mutton-fat KPs. Minimal anterior chamber cells or flare were seen and no patients had posterior synechiae or macular oedema. All patients were asked to stop their brimonidine drops once the diagnosis was suspected. In eight eyes (42.1%), topical corticosteroids were added. Resolution of signs occurred after two to eight weeks (mean 4.3 weeks) in eyes treated with topical corticosteroids and after four days to three weeks (mean 1.9 weeks) in eyes without steroid treatment. No patients developed recurrent uveitis following discontinuation of brimonidine. This side-effect may present with or without symptoms, sometimes many months after initiation of treatment. It may occur non-simultaneously in the two eyes, therefore appearing to affect only one eye of a patient on bilateral treatment. The authors of this paper highlight the fact that by simple cessation of the offending causative agent, numerous additional tests can be avoided. 

Brimonidine induced anterior uveitis.
Beltz J, Zamir E.
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Saruban Pasu

Moorfields Eye Hospital, London, UK.

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