Uveítis anterior granulomatosa bilateral como efecto adverso a brimonidina tópica

Objective: To present a case report of a bilateral granulomatous anterior uveitis secondary to treatment with topical brimonidine 0.2%. Case report: A 63-year-old male patient with history of glaucoma in both eyes, under topical treatment with brimonidine for 15 months, presented to the ophthalmology department with red eye, foreign body sensation and photophobia of 10 days of evolution. On physical examination his visual acuity (VA) was 8/10 in the right eye (OD) and 10/10 in the left eye (OI) better corrected. Biomicroscopy showed edema and hyperemia in palpebral edge, intense conjunctival hyperemia, papillary reaction in tarsal conjunctiva inferior, positive anterior chamber reaction, and granulomatous retrokeratotic precipitates in both eyes. Intraocular pressure measured with Goldman tonometer was 14 mmHg for the right eye (OD) and 15 mmHg for the left eye (OI). The fundus examination (FO) showed no particularities in both eyes. A series of complementary studies were requested to rule out other causes of uveitis, all of which were within normal parameters. In view of these findings, a diagnosis of bilateral granulomatous anterior uveitis secondary to topical brimonidine was proposed. Replacement of antiglaucomatous eye drops and treatment with mild topical steroids was indicated, with favorable response and complete resolution of the condition. Conclusion: In the present case, bilateral granulomatous anterior uveitis resolved completely after discontinuation of brimonidine and the administration of topical anti-inflammatory therapy, confirming the causal relationship with the drug.