Bilateral acute iris transillumination (BAIT) is a rare ocular condition characterized by acute pigment dispersion from the iris pigment epithelium (IPE), resulting in diffuse iris transillumination, atonic mydriatic pupils, and intraocular hypertension. BAIT is often associated with severe photophobia and requires extended medical management. Differentiating BAIT from related conditions such as bilateral acute depigmentation of the iris (BADI) is critical, as BAIT presents with a more severe clinical course and lasting complications. Trigger factors include respiratory infections and fluoroquinolone use, particularly moxifloxacin. This report details a case of BAIT following oral moxifloxacin use. A 69-year-old male patient presented with bilateral ocular redness, pain, and severe photophobia one day after receiving an influenza vaccination and one-week post-moxifloxacin treatment. Examination revealed bullous keratopathy and bilateral iris depigmentation with transillumination. Moreover, Goldmann applanation tonometry showed an elevated intraocular pressure (IOP) exceeding 35 mmHg. Initial management included antiviral, anti-inflammatory, and IOP-lowering agents, which improved symptoms but revealed persistent pigment dispersion, atonic pupils, and recurrent IOP elevation during corticosteroid tapering. Long-term treatment with carbonic anhydrase inhibitors and alpha-adrenergic blockers stabilized IOP, but persistent iris atrophy and pigment dispersion were noted after one year. Therefore, this case underscores the severe and persistent nature of BAIT, emphasizing the importance of distinguishing it from BADI and other conditions with overlapping features. Corticosteroid management requires careful tapering to prevent symptomatic recurrences, and long-term monitoring is crucial to avoid sequelae such as glaucomatous damage. The association with moxifloxacin highlights the need for caution when prescribing fluoroquinolones, especially in at-risk populations, to mitigate potential ocular morbidity.

Bilateral acute depigmentation of the iris and bilateral acute iris transillumination (BAIT) are similar clinical entities. The former causes acute-onset depigmentation of the iris stroma without transillumination, whereas the latter causes depigmentation of the iris pigment epithelium with transillumination. The etiopathogenesis of these conditions is not yet fully understood, but the proposed causes include the use of systemic antibiotics (especially moxifloxacin) and viral triggers. We present a case series of five female patients with a mean age of 41 (32-45) years, all of whom suffered acute onset of bilateral pain and redness of the eyes after moxifloxacin use (oral or topical). It is important for ophthalmologists to be aware of the two forms of iris depigmentation since this case series suggests that SARS-CoV-2 or its empirical treatment with moxifloxacin may trigger iris depigmentation. If this is the case, clinicians will likely see increased incidences of bilateral acute depigmentation of the iris and bilateral acute iris transillumination during and after the COVID-19 pandemic.

Bilateral acute depigmentation of the iris (BADI) is a rare disease characterized by iris atrophy. Although it can be self-limiting, it is sometimes progressive and can lead to glaucoma and severe vision loss. Two female patients were admitted to our clinic because of a change in iris color following coronavirus disease 2019 (COVID-19) infection. After the exclusion of other etiologies in the eye examination, BADI was diagnosed in both cases. Thus, it was shown that COVID-19 may also be involved in the etiology of BADI.

To present a case of bilateral acute iris depigmentation after covid 19 infection. A 55-year-old female presented with binocular pain and blurred vision a month after being diagnosed with severe acute respiratory syndrome - coronavirus-2 (SARS-CoV-2). She presented pigment dispersion in the anterior chamber and pigment depositions on the corneal endothelium. The patient was treated with dexamethasone and during follow-up visits, the pigment dispersion decreased and the symptoms ceased. Covid-19 infection may be associated with rare ocular disorders such as BADI.

Bilateral acute depigmentation of the iris (BADI) and bilateral acute iris transillumination (BAIT) are relatively new clinical entities characterized by acute pigment dispersion from the iris stroma or iris pigment epithelium, respectively. While BADI presents with diffuse or geographic areas of iris stromal depigmentation without transillumination, BAIT cases typically develop diffuse iris transillumination and mydriatic atonic pupils. Prolonged pigment dispersion and ocular hypertension are more common in BAIT. Although the exact etiopathogenesis is still unknown, moxifloxacin toxicity appears to be a probable/likely cause. The underlying cause of BADI or BAIT in patients who were not exposed to fluoroquinolone antibiotics remains unexplained. Systemic viral infections, including coronavirus disease 2019, may be the triggering event in several cases.