<p>Bilateral acute iris transillumination (BAIT) syndrome: literature review</p>

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.

Two Rare Causes of Anterior Pseudo-Uveitis Affecting the Iris: Sequelae of Bilateral Acute Iris Transillumination (BAIT) Syndrome and Iridocorneal Endothelial (ICE) Syndrome

“…Even though pigment dispersion in the anterior chamber is a major clinical sign for the diagnosis of BAIT [3], we saw the patient one year after the acute episode and pigment dispersion was no longer visible. The minimal or absent pigment dispersion was consistent with previous descriptions, indicating that pigment dispersion is re-absorbed over time [5]. The clinical picture led us to question the patient about previous antibiotic administration, which she confirmed, having been treated with clarithromycin one year before.…”

“…BAIT After a first report in 2004 [1] describing bilateral uveitis with pigment dispersion after the administration of moxifloxacin, the first series of iris atrophy cases was described in Turkey in 2005 and was called bilateral acute depigmentation of the iris [17]. It has since been reported in at least 10 other countries [5]. The bilateral involvement speaks against a herpetic virusinduced phenomenon, an improbable hypothesis as there is no ongoing inflammation.…”

“…Antibiotic intake after respiratory tract infections was found in 57 % of the 79 cases reported in the review article by Perone JM and al., in which 66 % of patients had taken moxifloxacin [5]. Most of the studies noted a correlation with the oral administration of antibiotics such as moxifloxacin and clarithromycin.…”

“…There may be inflammatory signs during the acute episode, but this was considered to be a consequence of the insult caused to the irises by a non-inflammatory cause. The explanation of the development of BAIT was quickly linked to the ingestion of antibiotics such as moxifloxacin or macrolides or others [5]. It is, however, not possible to exclude the possibility that BAIT could be produced by the diseases requiring antibiotic administration, mainly respiratory tract infections.…”

Causes of Iris Depigmentation in Young and Middle Age. Clinical Example

“…Подобная атрофия радужной оболочки имеет вид географической или диффузной зернистой депигментации с четко различимыми краями. В то же время синдром BAIT связан с потерей пигмента внутреннего эпителия радужки, что вызывает эффект трансиллюминации и сопровождается возникновением жалоб на светобоязнь [13,14].…”