Histopathologic Analysis of Conjunctival Lymphoproliferative Disease After Topical Brimonidine Use

Comparison of allergy prevalence using brinzolamide 1.0% / brimonidine 0.2% fixed combination with and without β-blocker in glaucoma patients: a retrospective cohort study

BACKGROUND

Glaucoma treatment often involves multi-drug regimens, which can lead to poor adherence and side effects. Fixed-dose combinations aim to improve adherence and reduce side effects compared to traditional therapies. This study aimed to compare the prevalence and clinical characteristics of ocular allergy in glaucoma patients using brinzolamide 1.0%/brimonidine 0.2% fixed combination (BBFC), with and without concurrent β-blocker.

METHODS

Of these, 176 patients used a β-blocker concurrently, whereas 96 patients did not. Allergy prevalence, allergy type, and allergy occurrence time were compared between the concurrent and non-concurrent β-blocker-usage groups. Ocular allergies were classified and evaluated using Kaplan-Meier survival analysis.

RESULTS

Allergy prevalence was 10.23% and 15.63% (p = 0.193), whereas allergy occurrence time was 15.92 ± 13.80 months and 6.26 ± 6.20 months (p = 0.04) in the concurrent and non-concurrent β-blocker-usage groups, respectively. Kaplan-Meier survival analysis indicated that half of the allergies in the concurrent β-blocker-usage group occurred within 12.5 months, with the BBFC discontinuation rate gradually increasing up to 36 months. Contrarily, half of the allergies in the non-concurrent β-blocker-usage group occurred within 3.3 months, with a rapid increase in BBFC discontinuation rate the first 6 months. Intergroup differences in allergy types were significant (p = 0.015). Among all patients with allergy, the average allergy occurrence time of blepharoconjunctivitis, papillary conjunctivitis, and follicular conjunctivitis was 12.52, 9.53, and 13.23 months, respectively. Follicular conjunctivitis tended to occur later than papillary conjunctivitis (p = 0.042). In the concurrent β-blocker-usage group, follicular conjunctivitis was the most prevalent allergy type (61.1%), whereas papillary conjunctivitis was the most common (66.7%) in in the non-concurrent β-blocker-usage group.

CONCLUSIONS

Concurrent use of β-blocker with BBFC decreases allergy prevalence, delays allergy onset, and predominantly results in follicular conjunctivitis, thereby facilitating longer treatment duration. Understanding these characteristics of allergy in BBFC users is useful to manage patients and improve treatment adherence. This study provides insights into the role of β-blockers in modulating ocular allergy in BBFC-treated glaucoma patients, highlighting implications for clinical practice and patient education.

Salmon patch-like conjunctival lesion secondary to long-term administration of topical brimonidine: A case report

INTRODUCTION

Brimonidine is a commonly used intra-ocular pressure-lowering agent for glaucoma patients. Allergic follicular or papillary conjunctivitis is a well-known side effect of brimonidine. Brimonidine is associated with ocular allergic symptoms such as conjunctival hyperemia, stinging sensation, photophobia and, in severe cases, corneal erosions. Here, we report a case of atypical conjunctival lesion following long-term administration of brimonidine.

CASE PRESENTATION

We report the clinical findings of a 72-year-old female presenting with a salmon patch-like conjunctival lesion affecting the bulbar and palpebral conjunctiva after long-term use of brimonidine. The finding was suspicious of conjunctival lymphoproliferative disorders. However, upon cessation of brimonidine, along with the administration of short-course topical steroid, a complete resolution of the lesion was evident. Biopsy was not performed as the clinical picture improved with conservative management. No recurrence was observed over 1 year follow up.

DISCUSSION

Atypical conjunctival lesions have been described after long-term use of brimonidine. These lesions can mimic the appearance of conjunctival tumors, specifically conjunctival lymphoproliferative disorders, for which multiple investigations are required including invasive conjunctival biopsy.

CONCLUSION

Careful observation is recommended for patients with a history of long-term use of brimonidine for the development of atypical conjunctival lesions which may simulate the appearance of conjunctival lymphoproliferative disorders.

A Narrative Review of Ocular Surface Disease Related to Anti-Glaucomatous Medications

Topical anti-glaucomatous medications are still the most important measure to lower intraocular pressure. Large number of studies have confirmed that long-term use of anti-glaucomatous eye drops, especially containing benzalkonium chloride, a preservative, can cause or aggravate ocular surface injury. Ocular surface diseases damage the ocular microenvironmental health status, reduce the patients’ compliance with the treatment, and finally affect the treatment result. Therefore, the ocular surface management of patients with glaucoma is very important. This includes the selection of drugs that are better tolerated according to individual conditions, preservative-free formulations, drugs that protect against ocular surface disease, or selecting surgery and laser treatment, to prevent the damage to the ocular surface by topical anti-glaucomatous drugs.

A review of neuropsychiatric adverse events from topical ophthalmic brimonidine

Brimonidine is a first-line topical medication for increased intraocular pressure and glaucoma which may be used alone or in conjunction with other topical therapies. Its structural and pharmacological comparabilities to clonidine give way to the hypothesis that it may cause neuropsychiatric side effects. The majority of case reports citing brimonidine toxicity, either for topical or peripheral exposure, include pediatric age groups but especially infants. Among the latter, a dose-response phenomenon is evident. Dose-response correlates have also been shown among adults. Case series and prospective double-blind treatment studies also give evidence for the occurrence of several central nervous system adverse reactions. Topical ophthalmic brimonidine use should be followed for the occurrence of neuropsychiatric disturbances generally, and enhanced vigilance should be maintained for at-risk populations.