Safety and efficacy of brimonidine in children with glaucoma

Purpose: Brimonidine is a relatively selective (x-agonist, which reduces intraocular pressure (IOP) by decreasing aqueous production and increasing uveoscleral outflow. Brimonidine passes through the blood-brain barrier, potentially causing central nervous system (CNS) toxicity. There have been reports of bradycardia, hypotension, hypothermia, hypotonia, and apnea in infants after topical brimonidine. Methods: We reviewed the IOP data and side effects of children at the Duke University Eye Center placed on brimonidine from June 1997 to October 2000. Brimonidine 0.2% was used for patients whose glaucoma was uncontrolled on maximal tolerated medical therapy. A monocular trial was performed whenever possible, and brimonidine was not prescribed for infants. Included were 32 eyes of 30 patients with uncontrolled IOP and varied glaucoma diagnoses. Results: The mean patient age was 10.5 years, with a mean follow-up on brimonidine of 10.8 months. Most patients were on other glaucoma medications. In 11 of the 32 eyes the IOP data could be interpreted, and in these eyes the IOP decreased from a mean of 22.5 +/- 4.9 mm Hg to a mean of 20.8 +/- 4.0 mm Hg (a mean decrease of 6.7% +/- 10%, P = .04) on brimonidine after a mean follow-up of 11.0 +/- 6.9 months. Two young children (ages 2.4 and 3.7 years) repeatedly were unarousable soon after the administration of brimonidine. Five other children experienced extreme fatigue after brimonidine administration. All symptoms resolved after brimonidine was discontinued. Discussion/Conclusions: Brimonidine should be used with caution in young children because of the potential for CNS depression. In selected patients, brimonidine has a substantial ocular hypotensive effect.