Volume 29, Issue 163, September 2025

Bilateral acute iris transillumination syndrome following oral moxifloxacin – a diagnostic challenge and review of the literature

Julia Krotofil^1♦, Julia Sztubińska¹, Julia Urbańska¹, Paula Szarek², Marta Tortyna¹, Olga Samsel¹, Danuta Borowska¹, Natalia Sioch¹, Kamil Nieczaj¹, Maciej Trzciński¹, Marta Urszula Marciniak¹

¹Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
²Faculty of Medicine and Health Sciences, Collegium Medicum, University of Zielona Góra, Zielona Góra, Poland

^♦Corresponding author
Julia Krotofil, Strzelców 20/8, 81‑586 Gdynia, Poland

ABSTRACT

Bilateral Acute Iris Transillumination (BAIT) syndrome is a unique, uncommon, drug-related ocular condition that presents with bilateral pigment dispersion, diffuse iris transillumination, and raised intraocular pressure (IOP), usually triggered by the fluoroquinolone compound moxifloxacin. The patients typically developed severe symptoms, including photophobia, unfocused vision, mid-dilated nonreactive pupils, and ocular pain. Because of its varied similarities among diseases such as viral anterior uveitis and pigment dispersion syndrome, bilateral anterior uveitis and iridocyclitis is often misdiagnosed; thus, patients are treated wrongly with excessive corticosteroid administration. This review explores the geographic distribution, clinical features, underlying risk factors, and potential mechanisms involved in BAIT, with particular emphasis on its strong association with oral moxifloxacin use. BAIT seems more common in 30 to 50-year-old females, with most cases described in Turkey and southern Europe and likely underdiagnosed in other parts of the world. Treatment is symptomatic or control of IOP with topical hypotensive agents, and corticosteroids are contraindicated. BAIT is typically self-limiting but has the potential to cause temporary or permanent vision effects. BAIT is an essential entity to recognize for accurate diagnosis and management, and further research is needed to better elucidate its long-term consequences and pathophysiology.

Keywords: bilateral acute iris transillumination, BAIT syndrome, moxifloxacin, pigment dispersion, differential diagnosis

Medical Science, 2025, 29, e154ms3638

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DOI: https://doi.org/10.54905/disssi.v29i163.e154ms3638

Published: 05 September 2025