A paradoxical ocular effect of brimonidine.

PURPOSE: We report an unusual paradoxical effect of brimonidine. DESIGN: Observational case report. METHODS: A 70-year-old woman with bilateral normal tension glaucoma was treated with topical brimonidine and followed in an outpatient setting. The main outcome measured was intraocular pressure (IOP) in mm Hg. RESULTS: Brimonidine was observed to cause IOP elevation, confirmed on rechallenge, scoring 8 (strong probability) on an adverse drug reaction probability score. CONCLUSION: Under certain circumstances topical brimonidine can cause paradoxical raised IOP necessitating vigilance in follow-up of patients on topical brimonidine.