Bilateral acute depigmentation of the iris in two siblings simultaneously

Area of Science:

• Ophthalmology
• Genetics
• Infectious Diseases

Background:

• Bilateral acute depigmentation of the iris (BADI) is a rare ocular condition.
• Previous reports of BADI have not originated from the Middle East or Africa.
• The etiology of BADI remains incompletely understood, with potential links to infection or genetic predisposition.

Purpose of the Study:

• To document the first simultaneous occurrence of BADI in two siblings.
• To describe the clinical presentation and management of BADI in this unique familial case.
• To highlight the potential role of genetic and infectious factors in the etiology of BADI.

Main Methods:

• Case report of two sisters presenting with symptoms of BADI.
• Clinical examination including anterior segment assessment and fundoscopy.
• Review of medical history for recent infections and family history.
• Treatment with topical corticosteroids, anti-glaucoma drops, and topical glanciclovir gel.

Main Results:

• Both siblings presented with bilateral ocular pain, redness, and photophobia.
• Anterior segment examination revealed circulating pigment, corneal pigment dusting, patchy iris depigmentation, and angle pigmentation.
• Both patients had recent upper respiratory tract infections.
• Visual acuity was preserved in both eyes for both patients.
• BADI was successfully managed with topical corticosteroids, anti-glaucoma medications, and topical glanciclovir.

Conclusions:

• This is the first reported case of simultaneous BADI in siblings globally and the first observation of BADI in the Middle East and Africa.
• The simultaneous occurrence in siblings suggests a possible genetic predisposition.
• The preceding upper respiratory tract infections indicate a potential infectious trigger for BADI.
• The findings support the hypothesis that both genetic and infectious factors may contribute to the etiology of BADI.