Acute depigmentation of the iris: a retrospective analysis of 22 cases.

OBJECTIVE

To present clinical manifestations of bilateral acute depigmentation of Iris (BADI) and bilateral acute iris transillumination (BAIT) and discuss its pathogenesis.

DESIGN

Retrospective descriptive case study.

PARTICIPANTS

Twenty-two patients diagnosed with BADI or BAIT.

METHODS

Case records of the above patients presented between May 2014 and November 2017 were retrospectively studied for history of present illness, clinical findings, and course of the disease.

RESULTS

Forty-one eyes of 22 patients were studied (17 cases of BADI and 5 cases of BAIT). Only 7 patients consumed oral fluoroquinolone (FQL), whereas 17 patients used topical FQL. Three patients did not use any FQL but did take ayurvedic medications. Seven patients had systemic viral prodrome, 12 had presumed viral conjunctivitis, and 3 had abundant sunlight exposure after FQL use (due to a road trip, sunbathing on a beach, and working as a traffic police officer). Three cases of BADI had unilateral depigmentation; 1 case of BAIT had iris transillumination only in one eye and a patch of depigmentation without transillumination in the other eye, akin to presentation of BADI. A PCR test for viral genome (HSV, VZV, CMV, and Rubella) revealed negative results in 2 cases of BADI and 3 cases of BAIT. Only 1 case of BADI had recurrence after 10 months.

CONCLUSIONS

Presentation of BADI and BAIT could be grossly asymmetric or unilateral. Clinical signs of BAIT and BADI can occur simultaneously in different eyes. The role of FQL in the pathogenesis of BADI and BAIT remains uncertain.