Per-Operative Bleeding Reduction From Using Brimonidine In Pterygium Surgery

Background: Topical brimonidine, a selective α2-adrenergic agonist that causes conjunctival vasoconstriction, is used to control bleeding during pterygium excision, but data on its use in routine practice are limited. Objective: To describe the pattern and extent of topical brimonidine use as an intraoperative hemostatic adjunct during pterygium excision, and to review the evidence base for its bleeding-reducing effect. Methodology: This prospective analytical study was conducted in the Cornea Department of Ispahani Islamia Eye Institute and Hospital, Dhaka. A total of 70 eyes of 70 patients undergoing pterygium excision were enrolled. In eyes managed with brimonidine, applicators soaked in brimonidine tartrate 0.2% were placed on the bleeding bed for hemostasis and counted per eye. Postoperative intraocular pressure (IOP) by non-contact tonometry was a secondary safety measure. Data were analyzed with IBM SPSS version 27. Intraoperative bleeding severity was not graded in routine records. Results: Brimonidine-soaked applicators were used in 45 of 70 eyes (64.3%), with a median of 4 applicators per eye (mean 4.1±2.1; range 1–8). The recurrent and double-headed pterygia required more applicators (7 and 6). Among brimonidine-treated eyes, postoperative IOP was unchanged (mean change +0.04 mmHg, 95% CI −0.82 to 0.91; p=0.92), and a postoperative IOP ≥21 mmHg occurred in 2 of 45 eyes (4.4%). Conclusion: Brimonidine-soaked applicators were a commonly used and IOP-safe intraoperative hemostatic adjunct in pterygium excision, consistent with published evidence that brimonidine reduces ocular surface bleeding. Prospective studies with graded intraoperative bleeding are required to quantify the hemostatic benefit. J.Natl.Inst.Ophthalmol.2025;8(1): 51-55