<p>Previous studies have reported that brimonidine, a widely used therapeutic agent, may be associated with vision-related adverse effects that can lead to serious clinical consequences. In this study, we conducted a comprehensive pharmacovigilance analysis of brimonidine-induced vision disorders using real-world data, combined with network toxicology and molecular docking to investigate underlying mechanisms. Pharmacovigilance analysis revealed that among adverse events (AEs) linked to brimonidine, ophthalmic AEs were the most common, among which vision disorders ranking third (3/10). We analyzed the mechanisms of four high-frequency vision disorders: blurred vision, visual impairment, reduced visual acuity, and blindness. By intersecting the pathogenic genes of these AEs with brimonidine’s predicted targets, 29 common genes were identified. Enrichment analysis highlighted key pathways associated with brimonidine-induced vision disorders, such as the ErbB signaling pathway, C-type lectin receptor signaling pathway, and HIF-1 signaling pathway. Subsequently, a protein-protein interaction network was constructed, which highlighted PIK3CA, SRC, and PTPN11 as the top hub proteins. Molecular docking confirmed stable interactions between brimonidine and these core targets. In conclusion, pharmacovigilance supports the vision safety assessment of brimonidine, while network toxicology provides mechanistic insights into its vision toxicity. These findings contribute to advancing clinical monitoring, risk management and mechanisms exploration of brimonidine-related vision disorders.</p>