To discuss an interesting and rare case of Brimonidine associated anterior uveitis in a POAG patient
Methods
A 57-year-old female presented with insidious onset right eye blurring of vision, redness, glare and pain for 2 months. She was a known POAG for 2 years, controlled on topical brimonidine and timolol. No history of ocular trauma, surgery and no known systemic illness. Her BCVA was 6/18 and 6/12 with IOP of 20 and 18 in right and left eye respectively. Right eye had ciliary congestion, mutton fat KPs, 1+ AC cells, normal vitreous, CDR of 0.8 with normal retino-choroid examination. Left eye was normal with CDR of 0.8. Diagnosis of right eye granulomatous acute anterior uveitis (AAU) with bilateral POAG was made. Detailed investigations revealed normal blood counts, ESR and CRP. Mantoux, serum ACE, serum calcium, chest Xray, HIV, VDRL and HLA-B27 were negative. All investigations were negative which led to suspicion of brimonidine associated AAU. Patient was shifted from brimonidine to brinzolamide and started on low dose topical 0.2% Loteprednol due to fear of steroid induced rise in IOP. At 1 week follow up, there was dramatic reduction in KPs. There was complete resolution of KPs at 3 weeks, with no recurrence at 3 months follow up.
Results
Patients on brimonidine can rarely present with acute uveitis which is completely reversible after cessation of drug. Such patients often do well without long term treatment with steroids.
Conclusion
Drug induced uveitis is a rare entity; however, treating ophthalmologists should have a high suspicion of it in patients receiving brimonidine for glaucoma. Timely diagnosis and cessation of drug can prevent unwanted investigations and long term steroid treatment.
Conflict of interest
No
1
Last name
MITTAL
Initials of first name(s)
H
Department
Ophthalmology
City
New Delhi
Country
India
2
Last name
Singh
Initials of first name(s)
R
Department
Ophthalmology
City
New Delhi
Country
India
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