An 18-month-old child with elevated intraocular pressure is prescribed brimonidine eye drops. The ophthalmologist stops the drug within days. What is the reason?

• A It raises intraocular pressure paradoxically in buphthalmic eyes
• B It causes irreversible miosis that masks disease progression
• C Risk of life-threatening apnoea, bradycardia and hypotension in children below 2 years ✓
• D It interferes with the metabolism of oral acetazolamide

Explanation

Brimonidine crosses the immature blood-brain barrier of infants and young children and causes central alpha-2 mediated respiratory depression, apnoea, bradycardia, hypotension and lethargy. It is therefore contraindicated below 2 years of age and used cautiously up to about 6 years. This paediatric safety point is heavily examined. It does not cause miosis or paradoxical pressure rise, and there is no relevant interaction with acetazolamide.

Reference: Shields' Textbook of Glaucoma, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.