Brimonidine (an alpha-2 adrenergic agonist) is preferred over beta-blockers in infants with glaucoma because beta-blockers can cause:
- A Mydriasis exacerbating angle-closure
- B Apnoea and cardiovascular depression via systemic absorption ✓
- C Cicatricial conjunctival changes preventing future surgery
- D Cataract formation when used long-term
Correct answer: B. Apnoea and cardiovascular depression via systemic absorption
Explanation
Topical beta-blockers (timolol) can be absorbed systemically through the nasolacrimal duct and cause serious cardiovascular and respiratory adverse effects in infants, including bradycardia, bronchospasm, and potentially fatal apnoea. Nasolacrimal occlusion after instillation reduces but does not eliminate systemic absorption. Notably, brimonidine itself crosses the blood-brain barrier in infants and causes CNS depression (apnoea, lethargy), so it is also used with caution in infants. Neither agent causes mydriasis.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.