Chapter 14 - Bilateral Pigment Dispersion

Abstract

A 35-year-old woman was referred for a second opinion on bilateral anterior uveitis. She complained of significant photophobia in both eyes. She was recently ill with bronchitis and treated with oral moxifloxacin. On examination, she had 4+ pigmented cells in the anterior chamber, multiple iris transillumination defects, intraocular pressure (IOP) in the high 20s on timolol 0.5% twice a day (BID) left eye (OU), and depigmentation of the iris in both eyes. She denied a history of trauma, vesicular skin lesions or cold sores, or a personal or family history of glaucoma. The differential diagnosis of such a presentation centers around causes of acute, bilateral pigment dispersion as opposed to anterior uveitis and includes bilateral acute iris transillumination syndrome and bilateral depigmentation of the iris. Pigment dispersion syndrome, the antecedent condition to pigmentary glaucoma, does not present with acute photophobia. The patient responded well to intensive topical corticosteroid therapy, which was tapered slowly over 2 months. These syndromes have been associated with preceding viral syndromes and with treatment with systemic moxifloxacin, although the latter association is weaker.