Bilateral granulomatous uveitis as a side effect of topical brimonidine: two case reports.

An 80 year old female in good general health was diagnosed with normal tension glaucoma and was prescribed Alphagant (brimonidine tartarate 0.2%) twice daily in both eyes. The intraocular pressure decreased from 15 mmHg to 11 mmHg bilaterally. The patient did not complain of any side effects when using the brimonidine drops. Exactly one year later, she presented with a sudden onset of chemosis, significant conjunctival injection, and keratic precipitates in both eyes. Her intraocular pressures had risen to 25 mmHg in the right eye and 35 mmHg in the left eye. She was still using brimonidine as sole ocular antihypertensive on a twice daily basis. The diagnosis of brimonidine-induced granulomatous anterior uveitis was made and Alphagant was discontinued. The patient was reexamined ten days later, at which time the uveitis had completely resolved. Then, latanoprost therapy was started. One month later, the intraocular pressure had dropped to 9 mmHg in the right eye and 10 mmHg in the left eye under latanoprost therapy, without any sign of recurrence of the uveitis.