Timeless Tips to remember

Raised intraocular pressure (IOP) and secondary glaucoma due to underlying uveitis is a well-acknowledged phenomenon (1). The clinician should however keep in mind that topical IOP lowering medications can in themselves be a specific cause of uveitis (2). The alphaadrenergic drug brimonidine, is known to induce a type of anterior uveitis, the so called 'brimonidine-associated uveitis', which results in anterior chamber inflammation and further IOP increase (3).

In glaucoma patients using brimonidine, one must consider this phenomenon to avoid misdiagnosis and over-treatment with topical steroids, which in turn may increase IOP and induce other side-effects. Stopping brimonidine in these patients is usually sufficient for the resolution of anterior chamber inflammation (4).

References

1.Siddique S, Suelves A, Baheti U, Foster S, Glaucoma and Uveitis,Survey of Ophthalmology 2013, 1-10 2.Moorthy RS, Moorthy MS, Cunningham ET Jr. Drug-induced uveitis. Curr Opin Ophthalmol. 2018 Nov;29(6):588-603 3.McKnight CM, Richards JC, Daniels D, Morgan WH. Brimonidine (Alphagan) associated anterior uveitis. Br J Ophthalmol. 2012;96:766–8 4.Beltz J, Zamir E. Brimonidine Induced Anterior Uveitis. Ocul Immunol Inflamm. 2016;24(2):128-33. doi: 10.3109/09273948.2015.1037845. Epub 2015 Sep 23. PMID: 26399160

Contributor: Prof. Verena Prokosch, Mainz, Germany Tip originally published: January 2021

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