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Bilateral granulomatous hypertensive anterior uveitis associated with prolonged treatment with brinzolamide/brimonidine fixed combination

Poster Details

First Author: J.Almendral-Gómez SPAIN

Co Author(s):    S. Aguilar-Munoa   A. Corrales-Benitez   C. Valor-Suarez   J. Garcia-Bella           

Abstract Details


Single case report. A 72-year-old woman with a history of bronchial asthma and IDDM came to the emergency room for pain, redness and blurred vision of subacute appearance in both eyes. She had undergone cataract surgery (OU), was pan-photocoagulated (OU), and suffered mild bilateral DME without intravitreal treatment. She also had chronic-open-angle-glaucoma OU (early stage Hodapp with MD <-6dB in CV), in treatment with fixed combination of brimonidine (0.2%) and brinzolamide (2%) for the last year. Previously, she had received treatment with travoprost and brinzolamide but the prostaglandins were withdrawn due to DME.


Hospital Universitario Clínico San Carlos (Madrid)


In biomicroscopic examination, mixed hyperemia was observed in 2+ OU with intense tarsal follicular reaction, granulomatous PRKs in the lower half of the endothelium, Tyndall 3+ in anterior chamber, and IOP of 40 mmHg OD and 45 mmHg OS.


Given the clinical suspicion of uveitis induced by brimonidine, this drop was removed and the patient was treated intensively with topical corticosteroids and oral acetazolamide, obtaining a complete recovery in 2 weeks and withdrawing corticosteroids without recurrence in the following weeks.


Uveitis induced by 0.2% brimonidine is a rare and relatively little known adverse reaction that usually occurs in patients with prolonged treatment with this drug. Published cases have usually received treatment for about 1 year and in many cases it is preceded by a chronic follicular conjunctivitis, which could be a risk marker. The mechanism involved could be a delayed hypersensitivity reaction.

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