Bilateral acute iris transillumination (BAIT) syndrome: literature review

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.

Keywords: BADI syndrome; BAIT syndrome; iris transillumination; moxifloxacin; photophobia; trabeculum pigmentary deposit.

Figure 1

World map illustrating the distribution of the described cases of bilateral acute iris transillumination (BAIT) syndrome around the world.

Figure 2

Bilateral acute depigmentation of the iris (BADI) syndrome with typical peripheral patchy loss of iris pigmentation. It is difficult to appreciate depigmentation. Iris autofluorescence has been described to enhance loss of pigments.

Figure 3

Typical picture of bilateral acute iris transillumination (BAIT) syndrome with iris transillumination on slit lamp examination and pupil deformation with associated semi-mydriasis. Notes: Picture reproduced from Perone JM, Reynders S, Sujet-Perone N, et al. Le syndrome de transillumination bilatérale aiguë de l’iris: case report [Bilateral acute iris transillumination: case report]. J Fr Ophtalmol. 2017;40(8):713-716. French. Copyright 2017, Elsevier Masson SAS. All rights reserved.⁷