Which side effect is associated with Brimonidine use?

• A. Follicular conjunctivitis
• B. Conjunctival hyperemia
• C. Dry eye
• D. Retinal detachment

Answer: (A)

Brimonidine, an alpha-2 agonist used to lower intraocular pressure, can provoke ocular surface reactions. The distinct, drug-related conjunctival reaction is follicular conjunctivitis—follicles appear on the palpebral conjunctiva and lids, often with itching and irritation due to a hypersensitivity response to the medication or its preservative. This type of immune-mediated conjunctivitis is more characteristic of a drug effect than simple redness from vasodilation. While conjunctival hyperemia is a common and nonspecific side effect with brimonidine, the presence of follicles points to an allergic conjunctivitis–type reaction linked to the drug. If this occurs, consider adjusting therapy or switching to another agent and treat symptoms with lubrication or antihistamines if needed. Retinal detachment isn’t a known association with topical brimonidine, and dry eye can occur but is less specific.