First Author: A.Vasquez Perez SPAIN
Co Author(s): X. Vazquez Dorrego D. Poposka
Purpose:
To describe a case of bilateral papillary conjunctivitis and granulomatous uveitis associated with long-term use of topical brimonidine 0.2% tartrate + timolol 0.5% (combigan ®).
Setting:
: Hospital Municipal de Badalona
Barcelona-Spain
Methods:
Case Report
Results:
A 74-year old male patient was diagnosed of open-angle glaucoma in both eyes 3 years ago. He was treated initially with topical timolol 0.5%(Timoftol 0.5®) but 6 months later to get better control of intraocular pressure (IOP) the treatment was changed to timolol 0.5% + brimonidine 0.2% tartrate (Combigan®). 18 months after initiated treatment with Combigan® the patient consulted for bilateral eye redness, pain and photophobia. The examination revealed bilateral papillary conjunctivitis and bilateral granulomatous uveitis, the IOP was 36 in the right eye and 38 in the left eye and there were no signs of vitritis and retinitis. A treatment with topical dexamethasone each 2 hours and cyclopentolate each 8 hours was initiated as well as the uveitis protocol was implemented. However after 5 days of treatment there was no evidence of any improvement and the serological results for infections and immune diseases were normal. After this brimonidine-induced uveitis was suspected and Combigan® was retired achieving improvement of the inflammatory signs progressively until total remission of uveitis and conjunctivitis after 2 weeks. The IOP also decreased to 22/23. Subsequently the patient continued treatment only with Travatoprost.
Conclusions:
Allergic conjunctivitis is a common reaction to topical treatment with brimonidine but brimonidine-induced granulomatous uveitis is a rare condition (about 20 cases reported), it is also a delayed reaction (after 1 year of treatment) and affects people over 70 years. Uveitis secondary to brimonidine should be suspected in elderly patients with uveitis refractory to treatment and after that other causes have been ruled out.
Financial Disclosure:
None
