Glaucoma: brimonidine allergy: practice question

A Ophthalmology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Ophthalmology · Glaucoma: brimonidine allergy

Sample item

After several months of brimonidine drops, a patient has red itchy eyes with follicles on the lower tarsal conjunctiva. What is the most likely cause?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. A delayed allergic reaction to the drug

Follicular conjunctivitis with itching after months of an alpha-2 agonist is a delayed hypersensitivity reaction and is the commonest reason for stopping the drug. The treatment is to stop it and switch class. Rebound redness is short-lived and without follicles.

Option by option

  • A. Chlamydial inclusion conjunctivitis

    Inclusion conjunctivitis occurs in sexually active adults with persistent mucopurulent discharge, not after starting a drop.

  • B. Adenoviral infection transmitted at tonometry

    Adenoviral infection would present acutely with a preauricular node and a watery discharge.

  • C. A delayed allergic reaction to the drug (correct)

    Correct. Delayed allergic follicular conjunctivitis is a recognised adverse effect of brimonidine.

  • D. Rebound hyperaemia as vasoconstriction wears off

    Rebound hyperaemia is a transient redness and does not produce follicles and itching over months.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Ophthalmology question

What is the answer to this Ophthalmology question?

The best answer is C, A delayed allergic reaction to the drug. Follicular conjunctivitis with itching after months of an alpha-2 agonist is a delayed hypersensitivity reaction and is the commonest reason for stopping the drug.

Why is "Chlamydial inclusion conjunctivitis" not the answer?

Inclusion conjunctivitis occurs in sexually active adults with persistent mucopurulent discharge, not after starting a drop.

Why is "Adenoviral infection transmitted at tonometry" not the answer?

Adenoviral infection would present acutely with a preauricular node and a watery discharge.

Why is "Rebound hyperaemia as vasoconstriction wears off" not the answer?

Rebound hyperaemia is a transient redness and does not produce follicles and itching over months.

What concept does this question test?

It tests Glaucoma: brimonidine allergy in Ophthalmology. The treatment is to stop it and switch class. Rebound redness is short-lived and without follicles.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Glaucoma: brimonidine allergy?

Group the red eye by what to examine and what the pupil does. Then use the flashcards and the other Ophthalmology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.