Suspected Brimonidine Allergy Associated With Severe Bilateral Conjunctivitis and Anterior Granulomatous Uveitis

Poster Presentations Poster 29 Spontaneous Closure of an Idiopathic Macular Hole Sharanjit Burmy, O.D., Richard Madonna, O.D., and Hanish Patel, O.D., SUNY State College of Optometry, 33 West 42nd Street, New York, New York, 10036 Background: Spontaneous closure of idiopathic macular holes occurs in a small number of cases. The mechanism is not clearly understood, but spectral domain OCT has enhanced visualization of the relationship between the vitreous and retina allowing insight into the potential causes of spontaneous closure. Case Report: A 65-year-old white woman presented for follow-up of an idiopathic macular hole in her left eye that had occurred 31 months earlier. Vision had been stable at 20/ 100 since cataract surgery about 6 months after the appearance of the hole. She had refused all other interventions including vitrectomy. On examination, it was noted that vision had improved to 20/60, and there was no clear evidence of the hole on fundus examination. Comparison of time domain OCT images with those taken previously showed closure of the hole with an overlying operculum attached to the separated posterior hyaloid face. Spectral domain OCT images clearly showed closure of the hole, an intact junction between the photoreceptor inner and outer segments, and complete separation of the posterior hyaloid. Conclusion: Spectral domain OCT has improved visualization of the vitreoretinal interface, allowing a better understanding of the cause of macular holes, their evolution, and characteristics of holes that close spontaneously. This may have implications into the development of future medical or surgical therapies.

Poster 30 Suspected Brimonidine Allergy Associated With Severe Bilateral Conjunctivitis and Anterior Granulomatous Uveitis Rachael Y. Miller, O.D., and Scott Anthony, O.D., Cleveland VAMC, 10701 E. Blvd., Cleveland, Ohio 44106 Background: Brimonidine tartrate is a selective alpha-2 agonist used for the treatment of glaucoma and ocular hypertension. Common side effects of brimonidine include itching, burning and redness, but only a few cases of granulomatous uveitis have been reported as a long-term reaction to brimonidine therapy. Case Report: An 83-year-old black man who was being treated for advanced primary open-angle glaucoma was referred from urgent care services for evaluation of severe red eyes OU. The patient had been treated with brimonidine bid OU since October 2006. He complained of red, itchy eyes for 2 weeks with mucus discharge and tearing OU, and he reported having a film over his eyes for 1 week with decreased vision O.D. Entering acuities were hand motion, not improving with pinhole O.D. and 20/40 1 2, not improving with pinhole O.S. Pupils were equal, round and

299 reactive to light with a positive relative afferent pupillary defect O.D. Slit lamp examination revealed a grade 3 follicular palpebral conjunctival reaction with grade 4 diffuse injection and follicular reaction of the bulbar conjunctiva OU. Keratic precipates were present O.S..O.D. with diffuse corneal staining, subepithelial infiltrates, and superficial punctate keratitis OU. A grade 2 anterior chamber reaction was present OU, and intraocular pressures were 15 mmHg OU. Dilated fundus examination revealed optic nerve head pallor OU. Laboratory testing was ordered, and the patient was treated with prednisolone acetate 1% qid OU. After 1 month of only mild improvement with prednisolone acetate and negative laboratory test results, brimonidine was discontinued. Upon discontinuation of bromonidine, there was marked improvement in visual acuity, ocular inflammation, and irritation. Conclusion: Long-term brimonidine therapy for the treatment of glaucoma and ocular hypertension has been reported to cause bilateral anterior granulomatous uveitis and conjunctivitis. Based on signs and symptoms of previously reported cases of bromonidine toxicity, negative laboratory test results, and marked improvement in ocular inflammation and irritation upon discontinuation of brimonidine, it is highly suspected that this patient had a latent adverse reaction to brimonidine. Therefore, it is important to consider topical medication toxicity as a potential etiology for ocular inflammatory processes.

Poster 31 Use of Interferon alpha b2 in Treatment of CornealConjunctival Intraepithelial Neoplasia Anne Vollmar, O.D., M.S., Diana De La Torre, O.D., and Stephanie Schmiedecke, O.D., Lake City VA Medical Center, 619 South Marion Avenue, Lake City, Florida 32025 Background: Corneal-conjunctival intraepithelial neoplasia (CIN), a precursor of squamous cell carcinoma, is a precancerous ocular surface lesion most commonly found in older fair-skinned individuals. Risk factors for developing CIN include ultra-violet exposure, smoking, human papilloma virus, and AIDS. Patients with CIN may present with symptoms such as foreign body sensation, redness, or decreased vision, or they may be asymptomatic. Although CIN is a slow-growing tumor, timely treatment and management is important because there is potential for local invasion or metastasis to regional lymph nodes. Traditionally, treatment of CIN consisted of excision with cryotherapy. However, topical chemotherapy agents such as Interferon (INF) alpha 2b are becoming a more common treatment method for CIN. Case Summary: A 63-year-old white man presented for a routine eye examination with no ocular complaints. Bestcorrected visual acuities were 20/20 in the right eye, and 20/20 in the left eye. Pupils and ocular motilities were