Salmon patch-like conjunctival lesion secondary to long-term administration of topical brimonidine: A case report

Brimonidine is a commonly used intra-ocular pressure-lowering agent for glaucoma patients. Allergic follicular or papillary conjunctivitis is a well-known side effect of brimonidine. Brimonidine is associated with ocular allergic symptoms such as conjunctival hyperemia, stinging sensation, photophobia and, in severe cases, corneal erosions. Here, we report a case of atypical conjunctival lesion following long-term administration of brimonidine.

We report the clinical findings of a 72-year-old female presenting with a salmon patch-like conjunctival lesion affecting the bulbar and palpebral conjunctiva after long-term use of brimonidine. The finding was suspicious of conjunctival lymphoproliferative disorders. However, upon cessation of brimonidine, along with the administration of short-course topical steroid, a complete resolution of the lesion was evident. Biopsy was not performed as the clinical picture improved with conservative management. No recurrence was observed over 1 year follow up.

Atypical conjunctival lesions have been described after long-term use of brimonidine. These lesions can mimic the appearance of conjunctival tumors, specifically conjunctival lymphoproliferative disorders, for which multiple investigations are required including invasive conjunctival biopsy.

Careful observation is recommended for patients with a history of long-term use of brimonidine for the development of atypical conjunctival lesions which may simulate the appearance of conjunctival lymphoproliferative disorders.