Histopathologic analysis of conjunctival lymphoproliferative disease after topical brimonidine use

Purpose: To describe of histopathological findings of conjunctival lymphoproliferative disease (CLD) after topical brimonidine use. Methods: This is a retrospective medical record review study, including histopathologic description. We reviewed the medical records of 208 patients (415 eyes) who were diagnosed with glaucoma and who were treated with topical brimonidine only for a minimum of 6 months. Of these, the medical records of 19 patients with suspected CLD clinical features were reviewed in detail. When CLD was suspected due to administration of brimonidine, histopathological analysis was performed by biopsy of these lesions. In addition, immunohistochemical staining was performed to analyze lymphocyte markers in some pathological tissues. Results: Nineteen patients had suspected CLD without definite irritative symptoms. Diffuse elevated (11 patients) or follicular lesion (8 patients) of salmon pink appearance was observed in inferior palpebral conjunctiva. Among these patients, 5 patients who agreed to conjunctival biopsy had histopathological findings of CLD such as reactive lymphoid hyperplasia (LH) (2 cases) or atypical LH (2 cases). The mean duration of brimonidine use was 29.00 ± 20.25 months (6-76 months). And follow-up period after discontinuation of brimonidine was 27.93 ± 11.87 months (12-58 months). At the last visit, complete resolution of the lesion was seen in 13 patients, and partial improvement was observed in 6 patients. Conclusions: We found 4 cases of CLD following long-term administration of brimonidine. However, large-scale additional studies should be performed to establish causality, to determine whether these novel side effects were caused by long-term brimonidine treatment.