Purpose

To describe cases developing bilateral acute depigmentation of the iris (BADI) following presumed SARS-CoV-2 respiratory tract infection.

Methods

We report 2 adult patients developing bilateral simultaneous and symmetrical depigmentation of the iris with pigment dispersion in the anterior chamber and pigment deposits on the back surface of the cornea following presumed SARS-CoV-2 respiratory tract infection. The depigmentation process spared the pupillary margins and no transillumination defects were elicited. The reported signs were incidentally discovered. Neither patient gave history of antibiotic therapy. Visual acuity remained unchanged and no significant rise in intraocular pressure was noted. Both patients had been following up in our uveitis service. Per our records, the reported iris changes developed after COVID-19. Patient (1) had presented 3 months earlier with HLA B27-related acute anterior uveitis in the right eye, while patient (2) had been diagnosed with bilateral chronic anterior uveitis and had been quiescent for 4 years under observation. She developed COVID-19 symptoms on the same day she was diagnosed with BADI.No treatment was administered

Results

We believe our reported cases developed BADI secondary to SARS-CoV-2 infection. Bilateral acute depigmentation of the iris (BADI) is a poorly understood finding that has been linked to viral respiratory tract infections. In contrast to herpetic infections, the involvement is bilateral and symmetrical as well as lacking in inflammatory signs. We excluded pigment dispersion due to lack of deposits on lens and lack of posterior iris bowing. SARS-CoV-2 viral RNA has been demonstrated in aqueous samples and corneal tissue by other groups. As illustrated in our second case, the depigmentation begins in the stage of viremia. The persistence of viral particles in the eye, as an immunoprivileged compartment, can possibly cause more dispersion of iris pigments.

Conclusions

Bilateral acute depigmentation of the iris (BADI) can occur secondary to SARS-CoV-2 infection. In the setting of COVID-19 global pandemic, the described changes that occur early in the disease, can possibly aid in detecting cases with COVID-19 before the symptoms fully develop.