Bilateral Acute Iris Transillumination Syndrome Following Oral Moxifloxacin Overdose

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.

Keywords: bait; bait syndrome; bilateral acute iris transillumination syndrome; glaucoma; moxifloxacin; uveitis.

Figure 1. Slit-lamp examination

Slit-lamp photographs of the right (A) and left (B) eyes show mid-dilated pupils (poorly responsive to light) and corneal microcystic edema.

Figure 2. Right eye slit-lamp and gonioscopy

Slit-lamp photographs of the right eye show pigment dispersion in the anterior chamber (A) and pigment deposition on the anterior lens capsule (B). A gonioscopy of the right eye shows dense inferior trabecular meshwork pigment deposition (C).

Figure 3. Iris transillumination defects

Slit-lamp photographs of the right (A) and left (B) eyes show diffuse iris transillumination defects with semi-mydriatic distorted pupils without pharmacologic dilation.