PDF(Pubmed)
Abstract：
A 32-year-old male, with juvenile open-angle glaucoma on chronic antiglaucoma therapy and recently introduced brimonidine eye drops to the treatment regimen, developed bilateral follicular conjunctivitis with subepithelial infiltrates (SEIs) initially resembling common infectious keratoconjunctivitis entities. The persistent nature of the conjunctivitis, the lack of positive conjunctival cultures, the absence of systemic symptoms, the full resolution of the condition upon discontinuation of antiglaucoma drops, and the commencement of topical steroids, along with the reappearance of SEIs upon reintroducing brimonidine; suggested an immune-mediated drug reaction secondary to a Benzalkonium chloride (BAK) preserved brimonidine tartrate 0.2% formulation. The interval between the initiation of brimonidine and the onset of the drug reaction was 13 months and shortened to 1 week upon re-exposure to the drug. The condition fully resolved without further sequelae off brimonidine. Brimonidine is notoriously known for causing ocular allergic reactions, the most common being follicular conjunctivitis, but very few reports exist describing its adverse effects on the cornea. This case highlights that brimonidine may directly or indirectly induce an immune reaction affecting the cornea in the form of SEIs. Brimonidine is, thus, capable of mimicking more commonly recognized infectious disease entities causing keratoconjunctivitis. This is the second report of a similar manifestation linked to its use.
摘要：
一个32岁的男性,与青少年开角型青光眼的慢性抗青光眼治疗和最近推出的溴莫尼定滴眼液的治疗方案，发展为双侧滤泡性结膜炎，上皮下浸润（SEIs）最初类似于常见的感染性角膜结膜炎实体。结膜炎的持续性，缺乏阳性结膜培养，没有全身症状，停止抗青光眼滴剂后病情的完全解决，以及局部类固醇的开始，随着重新引入溴莫尼定后SEIs的重新出现；提示免疫介导的药物反应继发于苯扎氯铵（BAK）保存的0.2％酒石酸溴莫尼定制剂。溴莫尼定开始和药物反应开始之间的间隔为13个月，并在再次暴露于药物后缩短至1周。病情完全解决，溴莫尼定没有进一步的后遗症。众所周知，溴莫尼定会引起眼部过敏反应，最常见的是滤泡性结膜炎,但是很少有报道描述其对角膜的不利影响。这种情况突出表明溴莫尼定可以直接或间接诱导以SEI形式影响角膜的免疫反应。溴莫尼定是,因此，能够模仿引起角膜结膜炎的更常见的传染病实体。这是与它的使用有关的类似表现的第二次报告。
