Brimonidine for glaucoma

Importance of the field: Brimonidine is a drug used in the management of glaucoma throughout the world and is the most modern alpha(2)-adrenoceptor agonist available. This review comprehensively discusses the use of brimonidine for glaucoma. Areas covered in this review: A historical insight into the development of selective adrenergic glaucoma drugs is given, followed by a description of the mechanisms of action and a discussion of the main clinical trials investigating clinical applications. The safety of brimonidine is evaluated, and our expert opinion is provided on how brimonidine is used in our clinical practice. The most relevant literature on the role of brimonidine in glaucoma is discussed. What the reader will gain: A clear understanding of the role of brimonidine for glaucoma treatment, with an explanation of its efficacy, limitations and use in clinical practice. Take home message: Brimonidine is an effective drug for lowering intraocular pressure. It has potentially serious systemic effects in children, in whom it is contraindicated. Its use in adults is limited by its ocular side effects such as allergy. Brimonidine is, however, an important part of the range of intraocular pressure lowering drugs available to prescribers.