J Korean Ophthalmol Soc > Volume 61(10); 2020 > Article
Journal of the Korean Ophthalmological Society 2020;61(10):1216-1220.
DOI: https://doi.org/10.3341/jkos.2020.61.10.1216    Published online October 15, 2020.
Two Cases of Atypical Allergic Conjunctivitis Caused by Topical Administration of Brimonidine
Seon Ha Bae, Kyoung Woo Kim, Yeoun Sook Chun
Department of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
브리모니딘 점안에 의해 유발된 비전형적인 알레르기결막염 2례
배선하, 김경우, 전연숙
중앙대학교 의과대학 중앙대학교병원 안과학교실
Correspondence:  Yeoun Sook Chun, Tel: 82-2-6299-1666, Fax: 82-2-825-1666, 
Email: yschun100@hanmail.net
Received: 23 January 2020   • Revised: 27 February 2020   • Accepted: 22 September 2020
To report two cases of atypical conjunctival lesions that differ from the well-known typical papillary or follicular conjunctivitis after the use of brimonidine.
Case summary
In the first case, a 46-year-old female patient diagnosed with binocular normal tension glaucoma visited our hospital. After topical application of 1% brinzolamide/0.2% brimonidine fixed-combination eye drops for 7 months, a number of yellow follicles confined to the left upper bulbar conjunctiva with mild conjunctival injection and conjunctival edema were observed under slit lamp microscopy examination. After stopping brimonidine for 2 weeks, conjunctival injection and follicles decreased and, 1 month later, bulbar conjunctival follicles had disappeared completely. Since changing the eye drops to a brinzolamide/timolol fixed combination, there was no recurrence of the condition. In the second case, a 70-year-old female patient who had been diagnosed with binocular normal tension glaucoma a year ago had been using 0.15% brimonidine. On slit lamp examination, bilateral eyelid edema and overall diffuse conjunctival tissue hypertrophy and multiple follicles appeared on the upper and lower palpebral conjunctiva, the bulbar conjunctiva, the conjunctival fornix, and the lacrimal caruncle. Bilateral conjunctival biopsy was performed to differentiate conjunctival lymphoma, and granulomatous inflammation was confirmed by biopsy. After stopping 0.15% brimonidine treatment and changing to latanoprost, conjunctival lesions improved and there was no recurrence.
If atypical conjunctival lesions are observed in patients using topical brimonidine, side effects related to brimonidine should be considered. Our results indicated marked improvement within 2 weeks of stopping brimonidine treatment.
Key Words: Allergic conjunctivitis, Atypical conjunctivitis, Brimonidine, Granulomatous conjunctivitis
브리모니딘 점안 후 전형적인 유두 또는 여포결막염과는 다른 비전형적인 결막병변을 보인 증례 2례를 보고하고자 한다.
46세 여자 환자가 양안 정상안압녹내장으로 진단받고 본원으로 내원하였다. 1% 브린졸라미드와 0.2% 브리모니딘 복합제제 점안 7개월 뒤 세극등현미경상 좌안 상측 구결막에만 국한된 다수의 노란색 여포들과 경미한 충혈 및 결막부종이 관찰되었다. 이에 약제 중단 후 2주 뒤 충혈이 호전되고 구결막 여포는 완전히 소실되었다. 이후 약제를 변경하여 점안 중이며 재발은 없었다. 70세 여자 환자가 1년 전부터 양안 정상안압녹내장으로 진단받고 0.15% 브리모니딘을 점안해왔다. 내원 당시 세극등현미경상 양안의 위아래 검결막, 구결막, 결막구석, 눈물언덕에 전반적인 미만성의 결막 조직 비대 및 다수의 여포들이 관찰되었다. 결막림프종 감별을 위해 양안 결막 절개생검을 시행하였으며 만성 육아종성 염증이 관찰되었다. 이에 약제 변경한 후 육아종이 호전되었으며 이후 재발은 없었다.
브리모니딘을 점안한 환자에서 비전형적인 결막병변이 관찰된다면 그 원인으로 브리모니딘을 의심해봐야 하며, 약제 중단 후 2주 내에 뚜렷한 호전을 기대해 볼 수 있겠다.

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