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Yu S, Sodhi M, Rezaeianzadeh R, Eadie B, Etminan M. Increased risk of pigmentary degeneration of the iris and pigmentary glaucoma with fluoroquinolone antibiotics. Eye (Lond) 2024:10.1038/s41433-024-03282-z. [PMID: 39069553 DOI: 10.1038/s41433-024-03282-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 06/26/2024] [Accepted: 07/22/2024] [Indexed: 07/30/2024] Open
Abstract
PURPOSE Fluoroquinolones are popular antibiotics used for a myriad of conditions including ocular procedures. Despite numerous case reports of acute pigmentary degeneration of the iris with fluoroquinolone use, a pharmacoepidemiological study has not been performed to examine and quantify this risk. DESIGN Retrospective cohort study with a case-control analysis. PARTICIPANTS A cohort of 1,231,881 new users of oral or topical moxifloxacin, levofloxacin, and azithromycin were followed to first diagnosis of pigmentary degeneration of the iris or pigmentary glaucoma. Four controls were selected for each case using density sampling, matching on age and calendar time. METHODS Users of oral or topical moxifloxacin were compared to levofloxacin and azithromycin, a negative control drug from a separate class. MAIN OUTCOMES AND MEASURES First incidence of pigmentary degeneration of the iris or pigmentary glaucoma. RESULTS The cohort was comprised of 1,231,881 new users of topical or oral levofloxacin, moxifloxacin, or azithromycin. 542 cases of pigmentary degeneration of the iris and 460 cases of pigmentary glaucoma were identified. The incidence of iris pigmentary degeneration or pigmentary glaucoma for topical moxifloxacin was 10.2/1000 person years compared to 2.6/1000 person years for topical azithromycin. Current topical moxifloxacin users had the highest adjusted IRR for pigmentary degeneration of the iris (IRR = 6.81, [95%CI:2.00-23.18]) and pigmentary glaucoma (IRR = 4.07 [95%CI:1.42-11.62]) respectively. CONCLUSIONS The study findings suggest that patients using topical moxifloxacin may have increased risk of developing pigmentary degeneration of the iris and pigmentary glaucoma although the absolute increase was low. Future studies are needed to confirm this association.
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Affiliation(s)
- Sabrina Yu
- Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Mohit Sodhi
- Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, BC, Canada
| | | | - Brennan Eadie
- Ophthalmology and Visual Sciences, Dalhousie University, Halifax, NS, Canada
| | - Mahyar Etminan
- Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, BC, Canada.
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Cronemberger S, Vasconcelos-Santos DV, Correia de Carvalho C, Carvalho JH, Calixto J, Diniz-Filho A. Bilateral acute iris transillumination (BAIT) syndrome: Differential diagnosis based on clinical, OCT and UBM findings. Eur J Ophthalmol 2024; 34:NP22-NP26. [PMID: 37160763 DOI: 10.1177/11206721231174489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
INTRODUCTION Bilateral acute iris transillumination (BAIT) is a relatively new syndrome whose etiopathogenesis is still not fully understood. It is characterized by acute bilateral onset of intense pigment dispersion in the anterior chamber, iris depigmentation with severe transillumination defects, accentuated pigment deposition in the angle, and elevated intraocular pressure (IOP). In literature, the first case was of bilateral acute iris depigmentation (BADI) reported in 2004 in a 77-year-old woman. In 2019, Perone et al. published a review about BAIT syndrome. They reported a total of 79 cases have been published up that date, mainly in Europe and especially in Turkey and Belgium. The majority of reported cases were of bilateral acute iris depigmentation (BADI). BAIT syndrome might be mainly confused with acute iridocyclitis, acute primary angle-closure (APAC) and pigment dispersion syndrome (PDS). In relation to BAIT, controversies still exist regarding the etiology being the differential diagnosis of paramount importance for adequate treatment. PURPOSE To report a case of BAIT syndrome associated to refractory glaucoma and to discuss the differential diagnosis based on clinical, OCT and UBM findings. METHODS We present a case of BAIT syndrome in which clinical, OCT and UBM findings have pointed out the similarities and, mainly the diagnosis differences with other ocular diseases. CONCLUSIONS BAIT syndrome with accentuated IOP rise must be differentiated of other ocular diseases. It requires urgent clinical therapy and/or surgical management as occurred in the present case for avoiding structural damage in OCT and visual field loss. OCT and UBM are critical for early recognition, differential diagnosis and management.
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Affiliation(s)
- Sebastião Cronemberger
- Department of Ophthalmology and Otorhinolaryngology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | - Júlia Calixto
- Department of Ophthalmology and Otorhinolaryngology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Alberto Diniz-Filho
- Department of Ophthalmology and Otorhinolaryngology, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Mendez Bermudez IJ, Ramirez Marquez E, Ayala Rodríguez SC, Ruiz-Justiz AJ, Rodriguez-Garcia EJ, Gonzalez M, Nieves I, Blasini M, Santos C, Oliver AL. Bilateral Acute Iris Transillumination Syndrome Following Oral Moxifloxacin Overdose. Cureus 2023; 15:e47426. [PMID: 38022122 PMCID: PMC10658970 DOI: 10.7759/cureus.47426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2023] [Indexed: 12/01/2023] Open
Abstract
We report a case of bilateral acute iris transillumination (BAIT) syndrome caused by an overdose of oral moxifloxacin in a Hispanic female patient with no previous respiratory viral infection. A 56-year-old Hispanic female with no history of ocular illness was referred to our glaucoma service to manage her microcystic edema, swelling, and refractory ocular hypertension. Her ocular and systemic symptoms, including progressively worsening bilateral ocular pain, severe photophobia, blurred vision, nausea, and vomiting, started 14 days after an accidental overdose of oral moxifloxacin. Moxifloxacin had been prescribed to treat a complicated urinary tract infection. A slit-lamp examination revealed bilateral microcystic corneal edema and transillumination in the right temporal iris, both consistent with a diagnosis of BAIT syndrome. The existing literature on BAIT syndrome is scarce, and its etiology remains unclear. This case provides clinical evidence supporting moxifloxacin toxicity as a possible cause of BAIT syndrome. We emphasize the importance of conducting extensive research to define the mechanisms involved in moxifloxacin-induced BAIT syndrome and to search for other potential etiologies of this condition.
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Affiliation(s)
- Israel J Mendez Bermudez
- Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, USA
| | | | - Sofía C Ayala Rodríguez
- Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, USA
| | - Armando J Ruiz-Justiz
- Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, USA
| | | | - Monica Gonzalez
- Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, USA
| | - Ileana Nieves
- Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, USA
| | - Marino Blasini
- Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, USA
| | - Carmen Santos
- Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, USA
| | - Armando L Oliver
- Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, USA
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Gorbea Fuxench GA, Ayala Rodríguez SC, Guardiola G, Ramos F, Pappaterra-Rodríguez M, Requejo Figueroa GA, Llop SM, Santiago LA, Santos C, Oliver AL. Bilateral Acute Iris Transillumination Associated with Moxifloxacin Antibiotic Use. Ocul Immunol Inflamm 2023:1-6. [PMID: 37652695 DOI: 10.1080/09273948.2023.2246543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/04/2023] [Accepted: 08/04/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE To describe the clinical and demographic characteristics and associated factors leading to bilateral acute iris transillumination (BAIT) syndrome. METHODS A retrospective review of patients with BAIT syndrome was performed. RESULTS Thirty-five patients with a diagnosis of BAIT were identified. The median age at presentation was 53 years; 80% of the patients were female. Twenty-six patients (74%) had recent histories of systemic antibiotic treatment. Of those with such a history, 24 patients (92%) had been receiving moxifloxacin. Two patients within our cohort were prescribed moxifloxacin prophylactically prior to a systemic surgical procedure and had no evidence of systemic illness or recent viral illness. CONCLUSIONS Our data support the notion that moxifloxacin might be associated with the onset of BAIT syndrome. Notably, within our cohort, two patients received moxifloxacin as surgical prophylaxis and subsequently developed BAIT syndrome. This could suggest a potential association between moxifloxacin and the onset of BAIT, though further studies are needed to confirm this finding.
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Affiliation(s)
- Gabriela A Gorbea Fuxench
- Department of Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, Puerto Rico, USA
| | - Sofía C Ayala Rodríguez
- Department of Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, Puerto Rico, USA
| | - Gabriel Guardiola
- Department of Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, Puerto Rico, USA
| | - Fabiola Ramos
- Department of Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, Puerto Rico, USA
| | - Mariella Pappaterra-Rodríguez
- Department of Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, Puerto Rico, USA
| | - Guillermo A Requejo Figueroa
- Department of Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, Puerto Rico, USA
| | - Stephanie M Llop
- Department of Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, Puerto Rico, USA
| | - Luis A Santiago
- Department of Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, Puerto Rico, USA
| | - Carmen Santos
- Department of Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, Puerto Rico, USA
| | - Armando L Oliver
- Department of Ophthalmology, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, Puerto Rico, USA
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Altan C, Basarir B, Bayraktar S, Tugal-Tutkun I. Bilateral Acute Depigmentation of Iris (BADI) and Bilateral Acute Iris Transillumination (BAIT)Following Acute COVID-19 Infection. Ocul Immunol Inflamm 2022:1-6. [PMID: 36083696 DOI: 10.1080/09273948.2022.2103832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
PURPOSE To report the presenting features and outcomes in patients who developed bilateral acute iris transillumination (BAIT) or bilateral acute depigmentation of iris (BADI) following acute COVID-19 infection. METHODS Thirty two eyes of 16 patients were reviewed retrospectively. The severity of COVID-19 infection, use of antibiotics, time of onset of ocular symptoms; ocular signs, the course and surgical procedures were recorded. RESULTS 24 eyes of 12 BAIT and eight eyes of four consecutive BADI patients were included. The mean time between infection and onset of ocular symptoms was 2.5±1.1 weeks. Nine patients were treated with oral moxifloxacin for COVID-19 prior to presentation. Trabeculectomy was performed in 7 eyes (21.8%) of 5 BAIT patients; in the postoperative follow-up, IOP was controlled without medication in 6 eyes, with medication in 1 eye. CONCLUSION BADI and BAIT can also develop after COVID-19 infection. A significant proportion of BAIT patients may require glaucoma surgery.
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Affiliation(s)
- Cigdem Altan
- Beyoglu Eye Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Berna Basarir
- Beyoglu Eye Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Serife Bayraktar
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.,Department of Ophthalmology, Bayrampasa Eye Hospital, Istanbul, Turkey
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Yüksel M, Özdemir HB, Özdek Ş, Gürelik G. Bilateral acute Iris transillumination after COVID-19 pneumonia. Eur J Ophthalmol 2022:11206721221113428. [PMID: 35850544 PMCID: PMC9297069 DOI: 10.1177/11206721221113428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To report the diagnosis, treatment and follow-up of a case of bilateral acute iris transillumination (BAIT) developed after COVID-19 pneumonia. METHOD Case report. CASE A 66-year-old male patient with COVID-19 pneumonia received systemic treatments of favipiravir, prednisolone, moxifloxacin and piperacillin-tazobactam during hospitalization. The patient applied to our clinic with the complaint of blurred vision 20 days after the diagnosis of COVID-19. The best corrected visual acuity (BCVA) was 0.3 in the right eye and 0.5 in the left eye. In the anterior segment examination; ciliary injection, intense pigment dispersion in the anterior chamber, pigment deposits on the lens and iris, 2-3 + cells in the anterior chamber, posterior synechia, and 360 degrees diffuse iris transillumination were observed in both eyes. The pupillary response to light was weak. Bilateral fundus examination were normal. In the anterior chamber sample; HSV, VZV, CMV and Toxoplasma PCR were negative. Bilateral acute iris transillumination (BAIT) diagnosed in the patient and topical 0.1% dexamethasone and topical 1% cyclopentolate were started. In the follow-up, visual acuity increased 1.0 in both eyes, there were no cells in the anterior chamber, and the pigment dispersion was still continuing despite a decrease. CONCLUSION BAIT, which can usually be seen after upper respiratory tract infections, can also be seen after covid 19 pneumonia and be kept in mind as a possible eye involvement in patients with COVID-19 infection.
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Affiliation(s)
- Murat Yüksel
- Department of Ophthalmology, 37511Gazi University School of Medicine, Ankara, Turkey
| | - Hüseyin Baran Özdemir
- Department of Ophthalmology, 37511Gazi University School of Medicine, Ankara, Turkey
| | - Şengül Özdek
- Department of Ophthalmology, 37511Gazi University School of Medicine, Ankara, Turkey
| | - Gökhan Gürelik
- Department of Ophthalmology, 37511Gazi University School of Medicine, Ankara, Turkey
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Rivera-Valdivia N, Arteaga-Rivera K, Reyes-Guanes J, Neira-Segura N, de-la-Torre A. Severe sequelae in bilateral acute iris transillumination syndrome secondary to the use of oral moxifloxacin: a case report. J Med Case Rep 2021; 15:462. [PMID: 34537056 PMCID: PMC8449864 DOI: 10.1186/s13256-021-03075-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 08/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background Moxifloxacin is a fourth-generation fluoroquinolone used as a second-line treatment for multiple bacterial infections. Uveitis has been described as an adverse effect related to this medication. Although several case reports have been published describing uveitis and bilateral acute iris transillumination syndrome related to moxifloxacin, we present a unique case of a patient with severe sequelae associated with bilateral acute iris transillumination syndrome secondary to the use of oral moxifloxacin. Case presentation A 45-year-old Colombian hispanic female presented bilateral conjunctival hyperemia, decreased visual acuity, blurred vision, photophobia, and ocular pain after 15 days of treatment with systemic moxifloxacin for an upper tract respiratory infection. The patient presented unilateral anterior chamber pigment dispersion, mydriatic and nonreactive pupils, extensive iris transillumination defects, and secondary glaucoma. Blood and aqueous humor tests were negative for infectious and autoimmune diseases. Moxifloxacin-induced bilateral acute iris transillumination syndrome was diagnosed. Permanent sequelae such as ocular pain, photophobia, and focus difficulty secondary to severe bilateral iridian atrophy and inability of synkinetic reflex were left. Additionally, glaucoma was diagnosed, and Ahmed valve implantation was required. Conclusions We should be aware of the possible association between moxifloxacin and bilateral acute iris transillumination syndrome. A detailed anamnesis, adequate examination, and laboratory tests are necessary to reach an early diagnosis and treatment to avoid unnecessary therapies. Larger studies should be carried out to understand the pathophysiology, diagnosis, management, and sequelae of the disease.
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Affiliation(s)
- Nicolás Rivera-Valdivia
- Escuela Barraquer Research Group, Escuela Superior de Oftalmología - Instituto Barraquer de América, Avenida Calle 100 # 18A - 51, Bogotá, Colombia
| | - Karla Arteaga-Rivera
- Escuela Barraquer Research Group, Escuela Superior de Oftalmología - Instituto Barraquer de América, Avenida Calle 100 # 18A - 51, Bogotá, Colombia
| | - Juliana Reyes-Guanes
- Escuela Barraquer Research Group, Escuela Superior de Oftalmología - Instituto Barraquer de América, Avenida Calle 100 # 18A - 51, Bogotá, Colombia
| | - Natalia Neira-Segura
- Escuela Barraquer Research Group, Escuela Superior de Oftalmología - Instituto Barraquer de América, Avenida Calle 100 # 18A - 51, Bogotá, Colombia
| | - Alejandra de-la-Torre
- NeURos research group, Escuela de Medicina y Ciencias de la salud, Universidad del Rosario, Carrera 24 # 63 C 69, Bogotá, Colombia.
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Klonner J, Salchow D. [Unusual anisocoria]. Ophthalmologe 2021; 118:597-599. [PMID: 32588124 PMCID: PMC8187173 DOI: 10.1007/s00347-020-01153-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Eine 53-jährige Patientin beklagte erhöhte Blendempfindlichkeit 3 Wochen nach Einnahme von Moxifloxacin-Tabletten bei Infekt der oberen Atemwege. Es bestand eine Anisokorie, die Pupillenreaktion, sowohl auf Licht als auch auf Naheinstellung, war aufgehoben. In der Untersuchung des vorderen Augenabschnittes fielen beidseits ausgeprägte Iristransilluminationsdefekte (ITD) auf. Wir diagnostizierten ein BAIT-Syndrom (bilaterales akutes Iristransilluminationssyndrom). Dies ist ein seltenes Syndrom, welches mit einer massiven Depigmentierung der Iris sowie einer Atrophie der Irismuskulatur einhergeht. Risikofaktor für die Entstehung eines BAIT-Syndroms scheint die orale Einnahme von Antibiotika, insbesondere Moxifloxacin, im Rahmen eines Infektes der oberen Atemwege zu sein, aber auch spontan auftretende Fälle sind beschrieben. Betroffen sind v. a. Frauen mittleren Alters. Die genaue Ursache des BAIT-Syndroms ist bisher unklar. Diskutiert wird ein möglicher Einfluss der Konzentration des Antibiotikums im Glaskörper. Differenzialdiagnostisch muss bei Iristransilluminationsdefekten insbesondere auch an Albinismus, intraokuläre Entzündungen, Pseudoexfoliationssyndrom und Pigmentdispersionssyndrom gedacht werden. Eine spezifische Therapie des BAIT-Syndroms besteht bisher nicht. Erhöhte Lichtempfindlichkeit und ein Post-BAIT-Glaukom können mögliche Komplikationen sein. Die Kenntnis des seltenen BAIT-Syndroms kann im klinischen Alltag hilfreich bei der differenzialdiagnostischen Einordnung einer Anisokorie sein und ggf. zur Vermeidung unnötiger diagnostischer Schritte beitragen.
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Affiliation(s)
- Jan Klonner
- Universitäts-Augenklinik, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
| | - Daniel Salchow
- Universitäts-Augenklinik, Leitung der Sektion Kinderaugenheilkunde, Strabologie/Orthoptik, Neuroophthalmologie, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
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Abstract
The diseases affecting the retina or uvea (iris, ciliary body, or choroid) generate changes in the biochemical or protein composition of ocular fluids/tissues due to disruption of blood-retinal barrier. Ocular infections and inflammations are sight-threatening diseases associated with various infectious and non-infectious etiologies. Several etiological entities cause uveitis, a complex intraocular inflammatory disease. These causes of uveitis differ in different populations due to geographical, racial, and socioeconomic variations. While clinical appearance is sufficiently diagnostic in many diseases, some of the uveitic entities manifest nonspecific or atypical clinical presentation. Identification of biomarkers in such diseases is an important aid in their diagnostic armamentarium. Different diseases and their different severity states release varying concentrations of proteins, which can serve as biomarkers. Proteomics is a high throughput technology and a powerful screening tool for serum biomarkers in various diseases that identifies proteins by mass spectrometry and helps to improve the understanding of pathogenesis of a disease. Proteins determine the biological state of a cell. Once identified as biomarkers, they serve as future diagnostic and pharmaceutical targets. With a potential to redirect the diagnosis of idiopathic uveitis, ocular proteomics provide a new insight into the pathophysiology and therapeutics of various ocular inflammatory diseases. Tears, aqueous and vitreous humor represent potential repositories for proteomic biomarkers discovery in uveitis. With an extensive proteomics work done on animal models of uveitis, various types of human uveitis are being subjected to proteome analysis for biomarker discovery in different ocular fluids (vitreous, aqueous, or tears).
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Affiliation(s)
- Reema Bansal
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amod Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Long-term Results of Trabeculectomy With Mitomycin-C in Patients With Bilateral Acute Iris Transillumination. J Glaucoma 2019; 28:797-802. [DOI: 10.1097/ijg.0000000000001309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Perone JM, Chaussard D, Hayek G. Bilateral acute iris transillumination (BAIT) syndrome: literature review. Clin Ophthalmol 2019; 13:935-943. [PMID: 31239635 PMCID: PMC6556534 DOI: 10.2147/opth.s167449] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 04/09/2019] [Indexed: 01/01/2023] Open
Abstract
The authors conducted a literature review about bilateral acute iris transillumination (BAIT) syndrome, a new and relatively unknown syndrome that should be described and made known to the greatest number to avoid potential diagnostic and therapeutic errors. The first cases date back only to 2004 and a total of 79 cases have been published to date, mainly in Europe and especially in Turkey and Belgium. It mainly affects young women between the ages of 30 and 50, and symptoms are often preceded by an upper airway infection. There is also a majority of cases where the onset of the syndrome follows oral intake of moxyfloxacin. The clinical signs are dominated by strong photophobia, secondary to a spectacular transillumination of the iris. Other classical symptoms are conjunctival infection, eye pain, blurred vision, temporary ocular hypertonia, fixed mid-dilated pupils, and pigment dispersion in the anterior chamber with pigmentary deposits in the trabecular meshwork in gonioscopy, symptoms that may be mistaken for uveitis. After a few weeks or months of evolution, persistent sequelae were pupillary atony and chronic and bilateral transillumination of the iris, leading to significant photophobia and sometimes persistent ocular hypertension. The BAIT syndrome is close to the bilateral acute depigmentation of the iris (BADI) syndrome, which is similar to BAIT but lacks associated transillumination. A few cases of patients with BAIT syndrome on one eye and BADI syndrome on the contralateral eye have been described, which confirms some form of link between the two clinical entities.
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Affiliation(s)
- Jean Marc Perone
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, Metz, France
| | - Dimitri Chaussard
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, Metz, France
| | - George Hayek
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, Metz, France
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13
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Altan C, Basarir B, Kesim C. An unexpected complication in bilateral acute iris transillumination: Cystoid macular edema. Indian J Ophthalmol 2018; 66:869-871. [PMID: 29786008 PMCID: PMC5989522 DOI: 10.4103/ijo.ijo_1134_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
A 47-year-old male presented with bilateral 4 + circulating pigment in the anterior chamber, diffuse iris transillumination, dilated pupils unresponsive to light, and high intraocular pressure (IOP) levels in both eyes. Visual acuity and IOP improved bilaterally with topical steroid and antiglaucomatous therapy. In the 10th month, bilateral cystoid macular edema (CME) was developed and resolved after subtenon triamcinolone injections. CME recurred after cataract surgery in the right eye which was treated with intravitreal dexamethasone implant injection. CME was recurred in the left eye and treated with intravitreal dexamethasone implant at the same setting with cataract surgery. CME can be seen in the course of bilateral acute iris transillumination (BAIT). This is the first BAIT case presenting with bilateral CME.
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Affiliation(s)
- Cigdem Altan
- Department of Eye Clinic, University of Health Science, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Berna Basarir
- Department of Eye Clinic, University of Health Science, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Cem Kesim
- Department of Eye Clinic, University of Health Science, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
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Den Beste KA, Okeke C. Trabeculotomy ab interno with Trabectome as surgical management for systemic fluoroquinolone-induced pigmentary glaucoma: A case report. Medicine (Baltimore) 2017; 96:e7936. [PMID: 29068979 PMCID: PMC5671812 DOI: 10.1097/md.0000000000007936] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
RATIONALE Bilateral acute iris transillumination (BAIT) is a poorly-understood ocular syndrome in which patients present with acute iridocyclitis and pigmentary dispersion with or without ocular hypertension. The etiology of the disease remains unknown, though recent reports suggest an antecedent upper respiratory tract infection or systemic antibiotic administration may trigger the clinical syndrome. PATIENT CONCERNS A 55-year-old female was referred for a second opinion regarding her bilateral ocular pain, photophobia, and ocular hypertension. Her medical history was notable for a diagnosis of pneumonia managed with oral moxifloxacin several weeks prior to her initial presentation. DIAGNOSES Visual acuity was 20/40 with an intraocular pressure (IOP) of 30 mmHg in the affected eye despite maximal tolerated medical therapy. The patient had severe bilateral iris transillumination defects with posterior synechiae formation and 3+ pigment with rare cell in the anterior chamber. This constellation of findings was consistent with a diagnosis of BAIT. INTERVENTIONS A peripheral iridotomy was placed, which mildly relieved the iris bowing, but did not affect the IOP or inflammatory reaction. The patient then underwent cataract extraction with posterior synechiolysis and ab interno trabeculotomy of the left eye with the Trabectome. OUTCOMES The patient's IOP on the first post-operative day was 13 mmHg, and anterior chamber inflammation was noted to be significantly reduced at post-operative week 2. The patient was recently seen at a 1-year post-operative visit and her IOP remains in the low teens on a low-dose combination topical agent. LESSONS Ophthalmologists should remain aware of the association between systemic fluoroquinolones and acute pigmentary dispersion that can progress to glaucoma. The Trabectome remains a viable option for management of pigmentary and uveitic glaucoma resistant to medical treatment.
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Affiliation(s)
| | - Constance Okeke
- Department of Ophthalmology, Eastern Virginia Medical School
- Virginia Eye Consultants, Norfolk, VA
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Rangel CM, Parra MM, Frederick G, Tello A, Varón CL. An unusual case of bilateral anterior uveitis related to moxifloxacin: the first report in Latin America. GMS OPHTHALMOLOGY CASES 2017; 7:Doc18. [PMID: 28706771 PMCID: PMC5506693 DOI: 10.3205/oc000069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective: To report a case of bilateral anterior uveitis secondary to oral moxifloxacin. Methods: Case report. Results: A 54-year-old female presented bilateral anterior uveitis following a 10-day course of oral moxifloxacin. She developed a bilateral anterior uveitis associated with pigment dispersion syndrome and iris transillumination. Conclusions: Drug-induced uveitis is one of the causes of anterior uveitis. Uveitis related to fluoroquinolones is a rare entity, there are few cases reported in the literature, this is the first case reported in Latin America.
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Affiliation(s)
- Carlos M Rangel
- Retina and Vitreous Department, Fundación Oftalmológica de Santander Clínica Carlos Ardila Lulle, Bucaramanga, Colombia
| | - M Margarita Parra
- Fundación Oftalmológica de Santander Clínica Carlos Ardila Lulle, Bucaramanga, Colombia
| | - Gabriel Frederick
- Fundación Oftalmológica de Santander Clínica Carlos Ardila Lulle, Bucaramanga, Colombia
| | - Alejandro Tello
- Anterior Segment and Refractive Surgery Department, Fundación Oftalmológica de Santander Clínica Carlos Ardila Lulle, Bucaramanga, Colombia
| | - Clara L Varón
- Retina and Vitreous Department, Fundación Oftalmológica de Santander Clínica Carlos Ardila Lulle, Bucaramanga, Colombia
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Mahanty S, Kawali AA, Dakappa SS, Mahendradas P, Kurian M, Kharbanda V, Shetty R, Setty SRG. Aqueous humor tyrosinase activity is indicative of iris melanocyte toxicity. Exp Eye Res 2017; 162:79-85. [PMID: 28712540 PMCID: PMC5563078 DOI: 10.1016/j.exer.2017.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 04/12/2017] [Accepted: 07/12/2017] [Indexed: 01/22/2023]
Abstract
Antibiotics such as fluoroquinolones (FQLs) are commonly used to treat ocular infections but are also known to cause dermal melanocyte toxicity. The release of dispersed pigments from the iris into the aqueous humor has been considered a possible ocular side effect of the systemic administration of FQLs such as Moxifloxacin, and this condition is known as bilateral acute iris transillumination (BAIT). Bilateral acute depigmentation of iris (BADI) is a similar condition, with iris pigment released into the aqueous, but it has not been reported as a side effect of FQL. Iris pigments are synthesized by the melanogenic enzyme tyrosinase (TYR) and can be detected but not quantified by using slit-lamp biomicroscopy. The correlation between dispersed pigments in the aqueous and the extent of melanocyte toxicity due to topical antibiotics in vivo is not well studied. Here, we aimed to study the effect of topical FQLs on iris tissue, the pigment release in the aqueous humor and the development of clinically evident iris atrophic changes. We evaluated this process by measuring the activity of TYR in the aqueous humor of 82 healthy eyes undergoing cataract surgery following topical application of FQLs such as Moxifloxacin (27 eyes, preservative-free) or Ciprofloxacin (29 eyes, with preservative) or the application of non-FQL Tobramycin (26 eyes, with preservative) as a control. In addition, the patients were questioned and examined for ocular side effects in pre- and post-operative periods. Our data showed a significantly higher mean TYR activity in the aqueous humor of Ciprofloxacin-treated eyes compared to Moxifloxacin- (preservative free, p < 0.0001) or Tobramycin-treated eyes (p < 0.0001), which indicated that few quinolones under certain conditions are toxic to the iris melanocytes. However, the reduced TYR activity in the aqueous of Moxifloxacin-treated eyes was possibly due to the presence of a higher drug concentration, which inhibits TYR activity. Consistently, immunoblotting analysis of the aqueous humor from both Ciprofloxacin- and Moxifloxacin-treated eyes showed the presence of soluble TYR enzyme, thus reflecting its toxicity to iris melanocytes and corresponding to its activity in the aqueous humor. Intriguingly, none of these patients developed any clinically appreciable ocular side effects characteristic of BAIT or BADI. Overall, our results suggest that topical antibiotics cause different levels of iris melanocyte toxicity, releasing dispersed pigments into the aqueous humor, which can be measured through TYR enzyme activity. Hence, we conclude that topical FQLs may cause subclinical toxicity to the iris melanocytes but may not be the sole cause of the development of BAIT or BADI.
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Affiliation(s)
- Sarmistha Mahanty
- Department of Microbiology and Cell Biology, Indian Institute of Science, Bangalore 560012, India
| | - Ankush A Kawali
- Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore 560010, India
| | - Shruthi Shirur Dakappa
- Department of Microbiology and Cell Biology, Indian Institute of Science, Bangalore 560012, India
| | | | - Mathew Kurian
- Department of Cataract, Narayana Nethralaya, Bangalore 560010, India
| | - Varun Kharbanda
- Department of Cataract, Narayana Nethralaya, Bangalore 560010, India
| | - Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore 560010, India
| | - Subba Rao Gangi Setty
- Department of Microbiology and Cell Biology, Indian Institute of Science, Bangalore 560012, India.
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Hinkle DM, Kruh-Garcia NA, Kruh JN, Broccardo C, Doctor P, Foster CS. Moxifloxacin Concentration and Proteomic Analysis of Aqueous Humor in Human Uveitis Associated with Oral Moxifloxacin Therapy. Open Ophthalmol J 2017; 11:107-116. [PMID: 28694894 PMCID: PMC5481612 DOI: 10.2174/1874364101711010107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 12/08/2016] [Accepted: 04/02/2017] [Indexed: 11/22/2022] Open
Abstract
PURPOSE The aim was to report the aqueous humor moxifloxacin concentration and proteome profile of an individual with bilateral uveitis-like syndrome with pigment dispersion. METHODS Multiple reactions monitoring mass spectrometry quantified the aqueous concentration of moxifloxacin in the affected individual. Shotgun proteomic analysis performed via liquid chromatography tandem mass spectrometry (LC-MS/MS) defined the protein profile in the affected individual and unaffected control samples. RESULTS Moxifloxacin was present at higher than expected levels in aqueous humor 18 days following oral administration. One-third of the proteins were identified by significantly lower spectral counts in the aqueous of the individual with moxifloxacin associated uveitis compared to the unaffected control. CONCLUSION Moxifloxacin was detected in aqueous humor 18 days following the completion of oral administration. These results suggest that moxifloxacin toxicity may be responsible for the uveitis-like syndrome with pigment dispersion syndrome induced by moxifloxacin therapy.
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Affiliation(s)
- David M Hinkle
- Department of Ophthalmology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Nicole A Kruh-Garcia
- Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | | | - Carolyn Broccardo
- Research Integrity and Compliance Review Office, Colorado State University, Colorado, USA
| | - Priyanka Doctor
- Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts, USA
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts, USA
- Ocular Inflammation and Uveitis Foundation, Cambridge, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Abstract
INTRODUCTION Drug-induced uveitis is a well described but often overlooked and/or misdiagnosed adverse reaction to medication. There are an increasing number of medications that have been related to the onset of intraocular inflammation. Identification of these inciting agents may decisively help the diagnostic algorithm involving new cases of uveitis. AREAS COVERED This review intends to be an updated comprehensive, practical guide for practitioners regarding the main drugs that have been associated with uveitis. A classification proposed by Naranjo et al. in 1981 for establishing potential causality is applied examining possible mechanisms of action. A guide for clinicians about the rationale of these observations when dealing with patients with uveitis is provided. EXPERT OPINION Several agents with different routes of administration (systemic, topical and/or intraocular) may cause intraocular inflammation. The mechanism behind ocular inflammation is frequently unknown. Clinicians should be aware of the potential drug effect to optimize diagnosis and management of such patients.
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Affiliation(s)
- Miguel Cordero-Coma
- Department of Ophthalmology, University Hospital of León , León , Spain +34 987237400 ; +34 987233322 ;
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Gonul S, Bozkurt B, Okudan S, Tugal-Tutkun I. Bilateral acute iris transillumination following a fumigation therapy: a village-based traditional method for the treatment of ophthalmomyiasis. Cutan Ocul Toxicol 2014; 34:80-3. [DOI: 10.3109/15569527.2014.886589] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Forooghian F, Maberley D, Albiani DA, Kirker AW, Merkur AB, Etminan M. Uveitis risk following oral fluoroquinolone therapy: a nested case-control Study. Ocul Immunol Inflamm 2013; 21:390-3. [PMID: 23876164 DOI: 10.3109/09273948.2013.808351] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine the risk of uveitis associated with the use of oral fluoroquinolones. METHODS Nested case-control study of all patients who visited an ophthalmologist in British Columbia, Canada, between 2000 and 2007, as captured in the British Columbia Health Linked Database. RESULTS A total 3383 incident cases of uveitis and 33,830 corresponding controls were identified. Among patients who had used oral fluoroquinolones within the past 30 days, the adjusted relative risk of uveitis was 3.53 (95% CI, 2.84-4.39). However, the relative risk of uveitis among patients taking oral macrolides and beta-lactams was also significantly elevated. CONCLUSIONS Our data do not provide convincing evidence of an association between fluoroquinolones and uveitis, as this study found an association between several classes of antibiotics and uveitis. It is possible that the systemic processes for which these antibiotics are being prescribed are in fact the inciting factors for the uveitis.
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Affiliation(s)
- Farzin Forooghian
- Department of Ophthalmology & Visual Sciences, University of British Columbia , Vancouver, British Columbia , Canada
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London NJS, Garg SJ, Moorthy RS, Cunningham ET. Drug-induced uveitis. J Ophthalmic Inflamm Infect 2013; 3:43. [PMID: 23522744 PMCID: PMC3637087 DOI: 10.1186/1869-5760-3-43] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 03/13/2013] [Indexed: 01/21/2023] Open
Abstract
A number of medications have been associated with uveitis. This review highlights both well-established and recently reported systemic, topical, intraocular, and vaccine-associated causes of drug-induced uveitis, and assigns a quantitative score to each medication based upon criteria originally described by Naranjo and associates.
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Affiliation(s)
- Nikolas JS London
- Retina Consultants San Diego, 9850 Genesee Avenue, Suite 700, La Jolla, CA, 92037, USA
| | - Sunir J Garg
- MidAtlantic Retina, The Retina Service of Wills Eye Institute, Thomas Jefferson University, 840 Walnut Street, Suite 1020, Philadelphia, PA, 19107, USA
| | - Ramana S Moorthy
- Associated Vitreoretinal and Uveitis Consultants, St. Vincent Hospital and Health Services, Indianapolis, IN, 46260, USA
- Associate Clinical Professor of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Emmett T Cunningham
- Department of Ophthalmology, California Pacific Medical Center, San Francisco, CA, 94115, USA
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, 94305-5101, USA
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Duncombe A, Gueudry J, Massy N, Chapuzet C, Gueit I, Muraine M. Pseudo-uvéite sévère associée à l’utilisation de moxifloxacine. J Fr Ophtalmol 2013. [DOI: 10.1016/j.jfo.2012.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Morshedi RG, Bettis DI, Moshirfar M, Vitale AT. Bilateral acute iris transillumination following systemic moxifloxacin for respiratory illness: report of two cases and review of the literature. Ocul Immunol Inflamm 2012; 20:266-72. [PMID: 22694259 DOI: 10.3109/09273948.2012.670359] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To describe two cases of bilateral acute iris transillumination following systemic administration of moxifloxacin and review the literature. METHODS Review of clinical records, and review of the literature using the PubMed database. RESULTS A 75 year-old man and 33 year-old woman presented with bilateral conjunctival injection, photophobia, and atonic, distorted pupils. The symptoms began acutely following a respiratory illness, for which both were treated with moxifloxacin. Both patients demonstrated profound iris transillumination, sectoral posterior bowing of the iris, corneal endothelial pigment dusting, and trabecular meshwork hyperpigmentation. One patient had a cotton-wool spot. A literature review identified 59 previous reports in 5 publications, including 17 patients with no antecedent fluoroquinolone use. CONCLUSIONS Increased awareness of this recently described clinical entity should lead to a decrease in unnecessary diagnostic evaluations. It is currently unclear whether this disease represents an adverse effect of fluoroquinolone use or a sequela of a systemic illness.
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Affiliation(s)
- R Grant Morshedi
- John A. Moran Eye Center, University of Utah, Salt Lake City, Utah 84132, USA
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Hinkle DM, Dacey MS, Mandelcorn E, Kalyani P, Mauro J, Bates JH, Soukasian SH, Holland GN, Foster CS, Fraunfelder FT, Davis JL, Fraunfelder FW. Bilateral uveitis associated with fluoroquinolone therapy. Cutan Ocul Toxicol 2011; 31:111-6. [PMID: 21981449 DOI: 10.3109/15569527.2011.617024] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Retrospective case series, database study and literature review. Forty case reports are described. OBJECTIVE To report a possible association between fluoroquinolones and uveitis. MATERIALS AND METHODS Spontaneous reports from the National Registry of Drug-Induced Ocular Side effects, World Health Organization, and Food and Drug Administration were collected on uveitis associated with systemic fluoroquinolone therapy. A literature review was performed using keywords "uveitis", "fluoroquinolones", and each individual fluoroquinolone name. Additional case reports were collected from the practices of six uveitis subspecialists and one neuro-ophthalmologist. MAIN OUTCOME MEASURES Data garnered from the reports include the type of fluoroquinolone, age, gender, adverse drug reaction (ADR), dosage, duration of therapy until onset of uveitis, concomitant drugs, systemic disease, dechallenge and rechallenge data. RESULTS A total of 40 case reports of uveitis associated with fluoroquinolones were identified including 12 men, 27 women, and 1 case in which the gender was not specified. The median age was 54 years. Dosage varied between the different fluoroquinolone drugs, with the median dosage within the range recommended in the package insert for each different fluoroquinolone. Median time from beginning of therapy to appearance of the ADR was 13 days (range 0-20 days). Thirteen patients were 60 years or older, and one patient was taking systemic anti-inflammatory steroids. There were five positive dechallenge case reports. DISCUSSION According to World Health Organization criteria, the relationship between fluoroquinolone therapy and uveitis is "possible". Causality assessments are based on the time relationship of drug administration, uveitis development, and dechallenge data. CONCLUSIONS Clinicians should be aware of a possible bilateral fluoroquinolone-associated uveitis, particularly the finding of iris transillumination and pigment dispersion.
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Affiliation(s)
- David M Hinkle
- MERSI, 5, Cambridge Center, 8th Floor, Cambridge, NY 02142, USA.
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Uveitis-like syndrome and iris transillumination after the use of oral moxifloxacin. Eye (Lond) 2011; 23:2260-2. [PMID: 19851342 DOI: 10.1038/eye.2009.234] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To report a newly recognized adverse effect of oral moxifloxacin. DESIGN Observational case reports. PARTICIPANTS Five patients who used oral moxifloxacin therapy. MAIN OUTCOME MEASURES In five patients, a uveitis-like episode followed oral moxifloxacin therapy, afterwards they experienced photophobia. At slitlamp investigation, the patients showed almost complete iris transillumination, not restricted to one sector, and persistent mydriasis of the pupil, with no reaction to light and no near reflex. Follow-up of 3 years in one of the patients showed no change of symptoms. Only in one patient, with a history of anterior uveitis, an anterior chamber tap was positive for herpes simplex genome. Only after the use of moxifloxacin did she experience continuous photophobia. CONCLUSIONS Iris transillumination and sphincter paralysis is a newly recognized adverse effect of oral moxifloxacin therapy.
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