Uveitis and ocular wall granulomas associated with brimonidine treatment

Abstract

AbstractPurpose Anterior granulomatous uveitis has been recently reported as a side effect of chronic topical use of brimonidine tartrate. Clinical features of eight patients with brimonidine induced uveitis and ocular wall granulomas are here described.Methods Medical history, ocular features, progress of events, pathological aspect, and clinical evolution of all patients were analyzed. For each patient, the search of systemic sarcoidosis was performed including angiotensin converting enzyme dosage, chest computed tomography and accessory salivary gland biopsy.Results Three women and five men with a mean age of 68 years (varying from 50 to 83 year‐old). All patients presented with glaucoma and two patients had a previous history of unilateral uveitis before treatment with brimonidine. Two patients receiving unilateral treatment had unilateral disease whereas patients receiving bilateral treatment had bilateral disease. At the time of diagnosis, the mean duration of treatment with brimonidine was 18.5 months. Epithelioid granulomatous lesions infiltrated conjunctiva and/or episclera. Remission was obtained after a 4 to 6 weeks of withdrawal. Uveitis and ocular surface inflammation flared up when treatment was tapered. Unfortunately, brimonidine was later reintroduced in one patient and diffuse granulomatous lesions recurredConclusion Brimonidine associated uveitis arises after sustained treatment in susceptible patients. Coexisting granulomatous anterior uveitis and ocular wall granulomas in patient treated by brimonidine eyedrops should evoke a drug induced disease. Treatment withdrawal leads to resolution of added inflammation with return to the basal state. Reexposure to brimonidine induce recurrence of uveitis after several months of exposure.