Effect of brimonidine tartrate 0.2% ophthalmic solution on pupil size

Purpose: To evaluate the effect of brimonidine tartrate 0.2% ophthalmic solution on pupil size under scotopic and photopic luminance conditions in persons considering laser refractive surgery. Setting: Ophthalmic Health Center, Tel Aviv, Israel. Methods: The pupil size was measured in 36 eyes of 36 participants under scotopic and photopic conditions using the Colvard pupillometer (Oasis Medical) before and after brimonidine tartrate drops were administered. The pupil size was subsequently measured after 30 minutes and 4 and 6 hours. Results: No difference was found in pupil size before brimonidine tartrate instillation in eyes with light or dark irides. Before instillation, the mean photopic pupil size was 4.81 mm ± 0.54 (SD) (range 4.0 to 6.0 mm). At 30 minutes, all pupils became miotic, with a mean size of 3.77 ± 0.51 mm (range 3.0 to 5.0 mm) (P<.0001). After 6 hours, 27.8% of the pupils had returned to their previous size. Before brimonidine tartrate administration, the mean scotopic pupil size was 6.22 ± 0.73 mm (range 5.0 to 8.0 mm). There was significant miosis to 4.57 ± 0.84 mm (range 3.0 to 6.5 mm) (P<.0001) that continued for at least 6 hours. The miotic effect of brimonidine tartrate was stronger in eyes with light irides. Conclusions: Brimonidine tartrate caused significant miosis, especially under scotopic conditions, most likely from its α-2 adrenergic effect. Under photopic luminance conditions, the miotic effect was pronounced.