Brimonidine Eye Drops Research Articles

Brimonidine-induced punctual eversion: An uncommon adverse effect

Brimonidine is a highly selective alpha-2 adrenoreceptor agonist which is primarily used to treat glaucoma and ocular hypertension. It has a well-known profile for adverse reactions, the common local ones being periocular dermatitis, allergic conjunctivitis, hyperaemia, and dry eyes. Here, we present two unusual cases of punctal eversion following the administration of brimonidine eye drops. On cessation of the medication, we could haul the progression of the condition. These cases highlight the importance of vigilance on the safety profile of drugs, manifestation of adverse drug reactions, and prompt withdrawal of the offending agent.

A combination of topical and systemic administration of brimonidine is neuroprotective in the murine optic nerve crush model.

forty-one Balb/c mice underwent unilateral ONC and were divided into three study groups: fifteen animals received saline drops twice per day and two additional IP injections of saline; fourteen mice received brimonidine drops twice per day; and 12 mice received brimonidine eye drops twice per day and two additional IP brimonidine injections. Animals were sacrificed seven days post-ONC, and immunohistochemical staining of retinal whole mounts was performed using neuronal NeuN and GFAP staining. Microscopic pictures of the central, middle, and peripheral regions of the retina were taken. The density of the retinal cells was assessed. The total RGC density after ONC and RGC densities in all retinal eccentricities were significantly higher in the brimonidine eye drop and IP combination treatment group than in the saline drop + saline IP, and brimonidine drop treatment groups. brimonidine eye drops supplemented with IP brimonidine injections improved RGC survival in a preclinical model of ONC.

Topical brimonidine for the management of facial erythema in rosacea: a histological, histometric, and immunohistochemical study.

Facial erythema in rosacea is a troublesome embarrassing presentation with limited options of treatment. Daily brimonidine gel was shown to be an effective modality of treatment. Being unavailable in Egypt and the scarcity of objective evaluation of its therapeutic effect motivated the search for other alternatives. To evaluate the use and effectiveness of topical brimonidine eye drops for the management of facial erythema in rosacea with the aid of objective assessment. The study was conducted on 10 rosacea patients presented with facial erythema. Brimonidine tartrate eye drops 0.2% were applied twice daily for 3 months on areas of red facial skin. Punch biopsies were obtained before and after 3 months of treatment. Routine hematoxylin and eosin (H&E) staining as well as CD34 immunohistochemical staining were performed for all biopsies. Sections were examined to detect the changes in the count and the surface area of blood vessels. Evaluation of clinical results showed good improvement of facial redness at the end of treatment (55-75%). Only 10% of subjects expressed rebound erythema. H&E and CD34 stained sections showed an increased count of dilated dermal blood vessels, which decreased significantly after treatment in count and surface area (P = 0.005, and P = 0.004, respectively). Topical brimonidine eye drops proved to be effective in managing facial erythema in rosacea, providing an available and cheaper alternative to brimonidine gel. The study improved the subjective evaluation in the context of objective assessment of treatment efficacy.

Brimonidine eye drops reveal diminished sympathetic pupillary tone in comatose patients with brain injury

BackgroundThere is an urgent need for easy-to-perform bedside measures to detect residual consciousness in clinically unresponsive patients with acute brain injury. Interestingly, the sympathetic control of pupil size is thought to be lost in states of unconsciousness. We therefore hypothesized that administration of brimonidine (an alpha-2-adrenergic agonist) eye drops into one eye should produce a pharmacologic Horner’s syndrome if the clinically unresponsive patient is conscious, but not if the patient is unconscious. Here, in a first step to explore this hypothesis, we investigated the potential of brimonidine eye drops to distinguish preserved sympathetic pupillary function in awake volunteers from impairment of sympathetic tone in patients in a coma.MethodsWe enrolled comatose patients admitted for acute brain injury to one of the intensive care units (ICU) of a tertiary referral center, in whom EEG and/or neuroimaging for all practical purposes had ruled out residual consciousness. Exclusion criteria were deep sedation, medications with known drug interactions with brimonidine, and a history of eye disease. Age- and sex-matched healthy and awake volunteers served as controls. We measured pupils of both eyes, under scotopic conditions, at baseline and five times 5–120 min after administering brimonidine into the right eye, using automated pupillometry. Primary outcomes were miosis and anisocoria at the individual and group levels.ResultsWe included 15 comatose ICU patients (seven women, mean age 59 ± 13.8 years) and 15 controls (seven women, mean age 55 ± 16.3 years). At 30 min, miosis and anisocoria were seen in all 15 controls (mean difference between the brimonidine-treated pupil and the control pupil: − 1.31 mm, 95% CI [− 1.51; − 1.11], p < 0.001), but in none (p < 0.001) of the 15 ICU patients (mean difference: 0.09 mm, 95% CI [− 0.12;0.30], p > 0.99). This effect was unchanged after 120 min and remained robust in sensitivity analyses correcting for baseline pupil size, age, and room illuminance.ConclusionIn this proof-of-principle study, brimonidine eye drops produced anisocoria in awake volunteers but not in comatose patients with brain injury. This suggests that automated pupillometry after administration of brimonidine can distinguish between the extremes of the spectrum of consciousness (i.e., fully conscious vs. deeply comatose). A larger study testing the “intermediate zone” of disorders of consciousness in the ICU seems warranted.

682: UNINTENTIONAL PEDIATRIC ORAL INGESTION OF BRIMONIDINE EYE DROPS

Introduction: Brimonidine is a central alpha-2 adrenergic agonist agent chemically similar to clonidine. When used for glaucoma treatment, activation of alpha-2 receptors in the ciliary musculature culminates in decreased intraocular pressure by reducing aqueous humor production and stimulating outflow. While intended use is intraocular, oral ingestion and associated neurological and cardiovascular toxicities are not robustly documented in pediatric literature. In this case report, we present the toxic oral ingestion of brimonidine eye drops in a pediatric patient. Description: A two year old, previously healthy female presented to the emergency department (ED) with acute altered mental status, found dizzy and unresponsive by her grandmother around 9pm; she was last known well before going to bed at 8pm. On arrival to the ED, the patient was crying, intermittently somnolent, and opening her eyes spontaneously. Her vital signs were as follows: temperature 97.2F, heart rate 79 beats per minute, respiratory rate 22 time per minute, blood pressure 126/86 mmHg. Venous blood gas showed respiratory alkalosis and lactate 2.1mmol/L. A urine toxicology screen was negative and serum acetaminophen, salicylate, alcohol, and tricyclic levels were undetectable. Head imaging and electrocardiograms were normal. Upon further review, the patient’s grandmother revealed she recently underwent kidney transplantation. She detailed that none of her oral medications were missing but had found an empty bottle of brimonidine eye drops under the couch. The grandmother was unable to share whether it was a 5mL or 15mL bottle of 0.1% or 0.2% eye drops. With concern that the patient may have ingested brimonidine, she received empiric intravenous naloxone 0.1mg/kg amounting to 1.5mg. Rapid improvement in wakefulness and mental status was observed. The child was admitted for monitoring in an intensive care unit, did not require any additional naloxone, and was discharged after approximately 36 hours. Discussion: Oral ingestion of brimonidine eye drops may cause somnolence and bradycardia in pediatric patients. Additionally, naloxone utilization may not elicit an appropriate response. This case describes the successful identification of toxicity and use of empiric naloxone for diagnostic and treatment purposes in a pediatric patient.

Reactivation of spontaneously resolved primary congenital glaucoma

A 15-year-old female was evaluated for elevated intraocular pressure (IOP). Ophthalmic examination showed bilateral enlarged corneal diameter, vertical Haab striae, concave iris, deep anterior chamber, and clear lens. IOPs in both eyes were 17 mm Hg with bilateral latanoprost, timolol/dorzolamide fixed-dose combination, and brimonidine eye drops. Immersion ultrasonography axial lengths were 26.1 and 25.6 mm in the right and left eyes, respectively. Ultrasound biomicroscopy of the right eye (Fig.

Comparing the effects and safety of dorzolamide hydrochloride + timolol maleate versus brimonidine after neodymium-doped yttrium aluminium garnet laser capsulotomy posterior capsule opacification.

Posterior capsular opacification is treated using neodymium-doped yttrium aluminium garnet laser capsulotomy that leads to increased intraocular pressure. Here, we compare the effects of dorzolamide hydrochloride + timolol maleate versus brimonidine on intraocular pressure. We also investigate their side effects after neodymium-doped yttrium aluminium garnet laser capsulotomy. In these patients, there are no prior studies comparing the results of these two drugs. Ninety patients with posterior capsule opacification contributed to the study. They received yttrium aluminium garnet laser capsulotomy. After yttrium aluminium garnet laser capsulotomy, they were randomized into three groups. Group 1 received dorzolamide hydrochloride + timolol maleate; Group 2 took brimonidine; and Group 3, the control group, took no drug. Group 1 took dorzolamide hydrochloride + timolol maleate eye drops 1 h before the procedure and on the third hour of the first day and two times per day between the second and the seventh days. Group 2 took brimonidine eye drops 1 h before the procedure and on the third hour of the first day, two times per day between the second and the seventh days. Brimonidine had a similar side effect profile to the fix combination. Intraocular pressure on the first (p = 0.87) and third days (p = 0.124) were similar in Group 1 (dorzolamide hydrochloride + timolol maleate), Group 2 (brimonidine) and the control group. The mean intraocular pressure value of the control group was significantly higher than Groups 1 and 2 because the anti-glaucomatous effects of the drugs become prominent on the seventh day (p = 0.041). In Group 1 and Group 2, intraocular pressure was significantly lower than the control group on the seventh day (p = 0.041). Stinging, itching, hyperemia and Tyndall rates were similar in Group 1, Group 2 and the control group. Watery eyes were less common in the brimonidine group than in the dorzolamide hydrochloride-timolol maleate and the control groups on the seventh day (p = 0.02). Brimonidine also significantly lowered the chemosis rate on the third (p = 0.04) and seventh (p = 0.03) days. We suggest that brimonidine and a combination of dorzolamide + timolol are similarly effective at reducing eye pressure for routine cases. In cases where intraocular pressure attacks might be at higher risk, using the dorzolamide + timolol combination would be more appropriate.

O27 Recurrent severe uveitis treated with secukinumab following anti-TNF induced cutaneous vasculitis in a patient with axial spondyloarthritis

O27 Recurrent severe uveitis treated with secukinumab following anti-TNF induced cutaneous vasculitis in a patient with axial spondyloarthritis

Influence of Different Concentrations of Carbachol Drops on the Outcome of Presbyopia Treatment – A Randomized Study

Purpose: To evaluate and compare in a masked fashion the influence of using two different concentrations of carbachol drops on the outcome of presbyopia treatment. Methods: A prospective, double-masked, randomized study. 57 emmetropic and presbyopic subjects aged between 44 and 60 years with an uncorrected distance visual acuity of at least 20/20 in both eyes without additional ocular pathology were eligible for inclusion. Subjects were divided into 2 groups. Group 1 (n=32 eyes) received single dose of 2.25% carbachol plus 0.2% brimonidine eye drops. Group 2 (n=25) received single dose of 3% carbachol plus 0.2% brimonidine eye drops. The subjects’ pupil size and both near and distance visual acuities were evaluated before and after treatment at 1, 2, 4, 8 and 12 hr, by a masked examiner at the same room illumination. Results: Statistically significant improvement in mean near visual acuity (NVA) was achieved in all subjects who received both concentrations of carbachol plus brimonidine drops (P &lt; 0.0001). Significant and sustained improvement in mean NVA was reported in higher concentrations of carbachol drops than in lower concentrations (P &lt; 0.0001). No serious adverse ocular effects were observed in any of the subjects of both groups. Conclusion: Based on the data, higher concentration of carbachol was found to be safe and provided greater efficacy in improving near visual acuity than lower concentration with prolonged duration of action.

Metal-organic frameworks, NH2-MIL-88(Fe), as carriers for ophthalmic delivery of brimonidine

We have proposed a metal-organic framework (MOF), NH2-MIL-88(Fe), as a novel carrier for topical drug delivery to the eye. The NH2-MIL-88(Fe) particles were prepared via a solvothermal synthesis method and their structure was confirmed by powder X-ray diffraction, Fourier transform infrared analysis, thermogravimetric analysis, electron microscopy, and N2 adsorption-desorption measurements. When brimonidine, an anti-glaucoma medicine, was encapsulated into NH2-MIL(Fe)-88 (i.e., NH2-MIL-88(Fe)/Br), the drug was loaded at 121.3 µg/mg and released in a sustained manner for up to 12 h. The NH2-MIL-88(Fe)/Br exhibited mucoadhesive properties and remained on rabbit eyes for a period of up to 4 h. Consequently, a high concentration of brimonidine was found in tears for a prolonged period after the administration of NH2-MIL-88(Fe)/Br, which resulted in a greater than two-fold increase in drug bioavailability and activity period compared with those of Alphagan P, which are brimonidine eye drops already approved for clinical use. Hence, NH2-MIL-88(Fe) is suggested to be a promising carrier for topical delivery to the eye that provides enhanced bioavailability of ocular drugs. Statement of SignificanceWe suggest NH2-MIL(Fe)-88, a type of metal-organic frameworks (MOFs), as delivery carriers of an ophthalmic drug, brimonidine. The NH2-MIL(Fe)-88 particles possess a mucoadhesive property, hence prolonged retention in the preocular space when topically administered to the eye. The particles can also encapsulate the drug in their micro-pores, through which the drug can be released in a sustained manner. Therefore, when tested to rabbit eyes in vivo, the drug-loaded NH2-MIL(Fe)-88 particles were shown to enhance the ocular drug bioavailability, as compared with Alphagan P, the marketed eye drops of brimonidine.

Amino-Functionalized Mesoporous Silica Particles for Ocular Delivery of Brimonidine

To treat glaucoma, conventional eye drops are often prescribed. However, the eye drops have limited effectiveness as a result of low drug bioavailability due to their rapid clearance from the preocular space. To resolve this, we proposed amino-functionalized mesoporous silica (AMS) particles as delivery carriers of the glaucoma drug, brimonidine. Because of the presence of mesopores, brimonidine (BMD) could be encapsulated in the AMS with a loading amount of 41.73 μg/mg (i.e., drug loading capacity of about 4.17%) to give the BMD-AMS, which could release the drug in a sustained manner over 8 h. BMD-AMS was also shown to be mucoadhesive due to the presence of both hydroxyl and amino groups in the surface, allowing for formation of hydrogen bonds and an ionic complex with the mucin, respectively. Therefore, when topically administered to rabbit eyes in vivo, BMD-AMS could reside in the preocular space for up to 12 h because of its adherence to the mucous layer. To assess in vivo efficacy, we examined the variance in intraocular pressure (IOP) and brimonidine concentration in the aqueous humor (AH) after applying BMD-AMS to the eye, which was compared with that induced by Alphagan P, the marketed brimonidine eye drops. For BMD-AMS, the duration in the decrease in IOP and the area under the drug concentration in the AH-time curve (AUC) were 12 h and 2.68 μg·h/mL, respectively, which were about twice as large as those obtained with Alphagan P; this finding indicated enhanced ocular bioavailability of brimonidine with BMD-AMS.

The Role of Brimonidine Eye Drops as an Adjunctive Therapy for Optic Nerve Protection in Patients with Controlled Open Angle Glaucoma

Objective: This study aims to evaluate the neuroprotective role of brimonidine eye drops in patients with controlled open angle glaucoma. Methods: This study is prospective and non-randomized. It was done between January,2014 and April, 2016. It included 33 eyes with controlled open angle glaucoma who were referred to Al Zahraa University Hospital. Brimonidine eye drops (BMD) were administrated. Follow up was done every 6 months for 12 months and three visual field (VFs) examinations were done to all patients using Humphrey Visual Field Analyzer II 745.Results: There is a gradual decline of IOP mean values from 15.3 ± 3.6 mmHg baseline to 13.5 ± 3.0 mmHg after 6 months and to 11.7±2.1 mmHg after one year of the use of BMD eye drops. The mean values of MD measurements showed improvement after BMD eye drops useas it becomes lower than baseline values after 6 months (-7.2 ± 5.2 vs -5.1 ± 3.7 respectively), with further improvement after one year of BMD eye drops use as it becomes lower than that after 6 months (-5.1 ± 3.7 vs -3.3 ± 3.6 respectively). Similarly, PSD measurements after 6 months (4.6 ± 3.1 vs 4.0 ± 3.1). Furthermore, measurement after one year of BMD eye drops use show more improvement as it becomes lower than measurements after 6 months (4.0 ± 3.1 vs 3.4 ± 4.4). Conclusion: Neuroprotection can be used to reduce the risk of glaucomatous progression independent of its effects on IOPas the future treatment modality.

Improved Presbyopic Vision With Miotics.

To evaluate the efficacy of using a parasympathomimetic drug (carbachol) with an alpha agonist (brimonidine) to create optically beneficial miosis to reduce the effect of presbyopia. In this prospective, double-masked, randomized, placebo-controlled clinical trial, 48 naturally emmetropic and presbyopic subjects aged between 43 and 56 years with an uncorrected distance visual acuity of at least 20/20 in both eyes without additional ocular pathology were eligible for inclusion. Subjects were divided into 2 groups. The treatment group (n=30 eyes) received single dose of 2.25% carbachol plus 0.2% brimonidine eye drops. The control group (n=18 eyes) received placebo drops. Drops were given to all subjects in a masked fashion, in their nondominant eye. The minimum posttreatment follow-up was 3 months. The subjects' pupil size and both near and distance visual acuities were evaluated before and after treatment at 1, 2, 4, 8, and 10 hr, by a masked examiner at the same room illumination. Statistically significant improvement in near visual acuity was achieved in all subjects who received carbachol plus brimonidine drops (P<0.0001). In this masked study, all subjects liked and would use this therapy if it was available. None would use the placebo. There was no evidence of tolerance or tachyphylaxis during the study period. Improving the depth of focus by making the pupil smaller caused statistically significant improvement in near visual acuity in emmetropic presbyopic subjects. Carbachol plus brimonidine seem to be an acceptable and safe alternative to corrective lenses and surgical procedures.

Brimonidine suppresses loss of retinal neurons and visual function in a murine model of optic neuritis

Optic neuritis is inflammation of the optic nerve and is strongly associated with multiple sclerosis (MS), an inflammatory demyelinating syndrome of the central nervous system. It leads to retinal ganglion cell (RGC) death and can cause severe vision loss. Brimonidine (BMD) is a selective α2-adrenergic receptor agonist that is used clinically for the treatment of glaucoma. BMD lowers intraocular pressure, but recent evidence suggests that its therapeutic efficacy may also mediate through mechanisms independent of modulation of intraocular pressure. In this study, we examined the effects of topical administration of BMD on retinal degeneration during optic neuritis in experimental autoimmune encephalomyelitis (EAE), an animal model of MS. EAE was induced with MOG35–55 in C57BL/6J mice and BMD eyedrops were applied daily. In the EAE retina, the number of RGCs was significantly decreased and this effect was suppressed with BMD treatment. Consistent with histological analyses, the visual impairment observed in EAE mice was inhibited with BMD treatment, indicating the functional significance of the neuroprotective effect of BMD. Furthermore, BMD increased the expression level of basic fibroblast growth factor in the EAE retina, particularly in Müller glial cells and RGCs. Our findings suggest that topical administration of BMD may be available for RGC protection during optic neuritis, as well as for glaucoma.

Accidental poisoning with brimonidine eye drops in a 9-day-old infant

Summary Brimonidine is a selective alpha-2-adrenergic agonist used to treat glaucoma. We report a case of a 9-day-old female who developed, 90 minutes after accidental ingestion of 3 eye drops of 0.2% brimonidine, coma, apnea, hyperglycemia and miosis requiring intubation and mechanical ventilation. Plasma concentration, 3 hours after intake, was 11.7 ng/mL. Normal consciousness was reached after 27 hours. Apnea recovered slowly, normal breath was reached 47 hours after accidental intake. This report adds to the existing evidence that brimonidine has serious systemic effects in newborns and can require fast and supportive management in intensive care unit.

Protection effect of sodium hyaluronate on ocular surface toxicity induced by Benzalkonium chloride-preserved brimonidine in rabbits

To investigate the protective effects of sodium hyaluronate on ocular surface toxicity induced by a prolonged use of benzalkonium chloride-preserved Brimonidine eye drops. Experimental study. Thirty adult female New Zealand rabbits were divided into three groups with randomized numbers design. Ten rabbits were treated with 0.2% Brimonidine eye drops and PBS (PBS group), the other ten rabbits with 0.2% Brimonidine combined with sodium hyaluronate eye drops (SH group), and control group received no treatment for 60 days. Schirmer test, fluorescein (FL) and Rose Bengal (RB) staining, conjunctival impression cytology specimens collecting were performed on day 0, 31, and 61. Apoptosis of conjunctival epithelium was detected by in situ terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay on day 61. Conjunctival inflammation was observed by hematoxylin eosin staining. Histomorphological changes of cornea and conjunctiva were observed by light microscopy, and scanning and transmission electron microscopy at day 61. Fluorescein and Rose Bengal scores were analysed by Kruskal-Wallis test. Schirmer scores, goblet cell density and inflammatory cells infiltration were analysed by repeated measures analysis of variance. There were significant differences in fluorescein and Rose bengal (H = 22.031, 15.303, P < 0.01) staining among the groups on day 61. Compared with the control group (FL: 0, 0-1, RB: 0, 0-1), fluorescein and Rose Bengal scores were significantly (P < 0.001) increased in PBS group (FL: 1.5, 1-2, RB: 1, 1-2), whereas was significantly (P < 0.001) decreased in SH group (FL:0, 0-1 RB:1, 0-1) when compared to PBS group. There were significant differences in aqueous tear production and goblet cell density (F = 7.980, 14.545, both P < 0.01) among the groups on day 61. Compared with the control group [(9.43 ± 0.57) mm, (87.73 ± 2.34/HP)], Schirmer scores and goblet cell density were significantly (P < 0.01) reduced in PBS-treated group [(6.61 ± 0.38) mm, (68.06 ± 3.61)/HP], but significantly (P < 0.05) increased in SH-treated group [(8.75 ± 0.57) mm, (82.31 ± 1.64)/HP] compared with PBS-treated group. The number of inflammatory cells was significant difference (F = 56.306, P < 0.001) among the groups on day 61. Compared with the control group [(39.89 ± 2.03)/HP], inflammatory cells infiltration was significantly (P < 0.01) increased in both PBS [(73.18 ± 2.17)/HP] and SH groups [(48.79 ± 2.64)/HP], however, SH-treated group was significantly lowered when compared with PBS-treated group. In addition, decrease in apoptosis, complete microvilli and cell organelles were found in the corneal and conjunctival epithelial cells in SH-treated group. Our results demonstrate that topical application of SH reduces the ocular toxicity and protect the ocular surface in the long term anti-glaucomatous medical therapies and may be considered as a vehicles or neutralizing material for future ocular application.

Uveitis and ocular wall granulomas associated with brimonidine treatment

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.

Contrast Sensitivity and Eye Drops

Purpose: To evaluate the influence of commonly used eye drops on contrast sensitivity (CS). Design: Prospective study. Participants: One hundred twenty volunteers (120) were enrolled. Methods: The CS of ophthalmologically healthy individuals was evaluated at baseline examination before the instillation, 20 and 40 minutes after the instillation of diclofenac sodium and commonly used antiglaucoma eye drops (latanoprost, brimonidine tartrate, combination of dorzolamide hydrochloride and timolol maleate). CS was assessed at 7 spatial frequencies varying from 1.5 c/d to 20 c/d by the use of Mentor B-VAT II-SG video acuity tester. Results: Diclofenac sodium induced a mild, however statistically significant decrease on the CS in 4 out of 30 subjects 20 minutes after instillation at the spatial frequency of 1.5 c/d and 3 c/d (p p > 0.05). Brimonidine tartrate decreased CS in 4 out of 30 subjects 20 minutes after the instillation at a high spatial frequency (20 c/d) yet this decrease was marginally statistically significant (p = 0.057). CS returned to baseline scores 40 minutes after the instillation for all drugs. Conclusions: Diclofenac sodium eye drops had a mild temporal effect on the low spatial frequencies of 1.5 c/d and 3 c/d in some individuals. Latanoprost and dorzolamide/timolol had a non-statistically significant effect on the same spatial frequencies. Brimonidine eye drops had a temporal effect on the high spatial frequency of 20 c/d with marginal statistical significance. The CS scores returned to normal, in all cases, within the next 40 minutes after the instillation. Ophthalmologists should be aware of the fact that some eye drops may have an influence on CS.

Adherence with brimonidine in patients with glaucoma aware and not aware of electronic monitoring

To assess the impact of open versus masked adherence monitoring on adherence with topical brimonidine using two different dosing schedules. Thirty-seven patients with glaucoma or ocular hypertension were enrolled in a prospective, observational cohort study. Patients were randomly assigned to open or masked adherence monitoring and to brimonidine twice daily (BID) or three times daily (TID). Patients received conventional brimonidine eye drops with attached electronic monitoring devices for 4 weeks with weekly intraocular pressure measurements. Adherence calculations comprised dosing intervals, adherence rate and time covered. Subgroup analysis with anova included the factors masking, regimen, diagnosis and age. Among 36 individually analysed patients, 12 (33%) had adherence rates above 75%, therein two (5%)>90%. The mean adherence rate in 19 patients aware of adherence measurements was 70 ± 17% for brimonidine BID and 65 ± 14% for TID, not significantly different to the rates of 17 patients not informed about adherence measurements (77 ± 6% BID, 62 ± 9% TID, p = 0.24). On average, patients with brimonidine TID achieved significantly lower adherence rates (64 ± 12%) than patients on BID (73 ± 13%, p = 0.02). Still, patients on TID applied brimonidine more often (TID 1.9 ± 0.3, BID 1.5 ± 0.1 mean applications per day). The median coverage was 70% and showed no statistically significant difference between patients on BID and TID (p = 0.36). The study findings suggest that adherence measurements are not significantly altered by open adherence monitoring, which may simplify future adherence studies. Adherence with brimonidine eye drops was insufficient for most patients. These results demonstrate the necessity to develop new strategies to improve compliance in glaucoma therapy.

Reversible Cicatricial Ectropion Precipitated by Topical Brimonidine Eye Drops

Bilateral cicatricial ectropian was precipitated by topical brimonidine eye drops. On discontinuation of the drug, the ectropian resolved. Patients on brimonidine who develop cicatricial ectropian should not be managed surgically at first presentation.