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P. A. Labalette, N. Franquet, L. Nouvel, O. Kerdraon, C.-A. Maurage; Uveitis With Conjunctival and Episcleral Granulomas Associated With Brimonidine Treatment. Invest. Ophthalmol. Vis. Sci. 2010;51(13):3786.
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The spectrum of drug induced uveitis expands with introduction of newer active medications. Anterior granulomatous uveitis has been recently reported as a side effet of chronic topical use of brimonidine tartrate. In this study, we describe the clinical features of patients with brimonidine induced uveitis and ocular wall granulomas.
Seven patients presented with uveitis and granulomatous ocular wall infiltration induced by brimonidine topical treatment were included. Medical history, ocular features, progress of events, pathological aspect, and clinical evolution were analyzed. For each case, the search of systemic sarcoidosis was performed including chest computed tomography and accessory salivary gland biopsy.
Two women and five men with a mean age of 67 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. All but two patients receiving unilateral treatment had bilateral disease. At the time of diagnosis, the mean duration of treatment with brimonidine was 18 months. Epithelioid granulomatous lesions infiltrated both conjunctiva and episclera. Remission was obtained after about six weeks of withdrawal. Underlying sarcoidosis was suspected in one case but withdrawal of brimonidine allowed resolution of inflammation.
Brimonidine associated uveitis arises after sustained treatment. Ocular inflammation happens only in treated eyes of susceptible patients. Coexisting granulomatous anterior uveitis and ocular wall granulomas in patient receiving brimonidine eye drops should evoke a drug induced disease.Treatment withdrawal leads to resolution of added inflammation with return to the basal state.Associated granulomatous uveitis and ocular wall granulomas in patients receiving topical brimonidine tartrate should lead to stop the treatment to assess causality. As a precaution, brimonidine should be avoided in patients presenting granulomatous anterior uveitis.
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