Inflammatory Cells and Lipid Deposits Detected by in Vivo Confocal Microscopy in Brimonidine Tartrate Ophthalmic Solution-Related Corneal Disorders: A Case Series

We reviewed the medical charts of five patients diagnosed with brimonidine tartrate (BT)-related corneal disorders. A fan-shaped corneal opacity was present in four patients and limbal corneal infiltrations were present in one patient. In vivo confocal microscopy revealed dendritic cells and lipid deposits in the fan-shaped opacity as well as neutrophils in limbal infiltrations. BT instillation was discontinued and topical administration of a corticosteroid was initiated for all patients. The limbal infiltrations improved after BT discontinuation. Conversely, the fan-shaped opacity remained in all affected patients. After a fan-shaped opacity has developed in a patient with a BT-related corneal disorder, the lesion is difficult to resolve. However, limbal infiltrations respond well to treatment. Therefore, BT should be discontinued and anti-inflammatory treatment initiated before a fan-shaped opacity forms.

Automated summary

This study reviewed the medical charts of five patients with brimonidine tartrate (BT)-related corneal disorders. Four patients had fan-shaped corneal opacity, while one patient had limbal corneal infiltrations. Confocal microscopy showed dendritic cells and lipid deposits in the fan-shaped opacity and neutrophils in limbal infiltrations. Discontinuation of BT and corticosteroid treatment improved the limbal infiltrations, but the fan-shaped opacity persisted. Therefore, it is important to discontinue BT and initiate anti-inflammatory treatment before the development of a fan-shaped opacity.