Correspondence Address:
Dr. Vijayalakshmi A Senthilkumar
Department of Glaucoma, Aravind Eye Hospital and Postgraduate Institute of ophthalmology, Madurai, Tamil Nadu
India

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An 80-year-old elderly male presented with redness and lid edema in the left eye (LE) for 2 weeks. He was diagnosed to have secondary glaucoma postvitreoretinal surgery in the LE 2 years back and treated with combination therapy consisting of timolol maleate 0.5% and brimonidine tartrate 0.2% twice daily in the LE. His best-corrected visual acuity and intraocular pressure in the LE were 6/36 and 24 mmHg, respectively. Slit-lamp examination LE revealed severe periorbital edema, dermatitis over the lower lid, injected palpebral and bulbar conjunctiva, and follicles in the lower palpebral conjunctiva and clear cornea with pseudophakia [Figure 1]a. A provisional diagnosis of brimonidine-induced allergic blepharoconjunctivitis was made. The drug was stopped immediately and shifted to alternate antiglaucoma medications. All the allergic reactions subsided within 2 weeks of stopping the drug, thus confirming our diagnosis [Figure 1]b. Allergic reactions to brimonidine consists of allergic contact dermatoconjunctivitis or follicular conjunctivitis with reported rates up to 25% and rarely granulomatous uveitis.[1],[2] The delayed hypersensitivity reaction due to brimonidine drug as follicular conjunctivitis without corneal involvement occurs within the first 9 months, but may be delayed up to 15 months after treatment is started.[3] This allergic reaction resembles a viral conjunctivitis, but the cornea is not involved here. Distinguishing between these two clinical entities is critical in the management of these patients.{Figure 1}

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