Graefe’ s Arch Clin Exp Ophthalmol (2006) 244: 742–746 SHORT COMMUNICATION DOI 10.1007/s00417-005-0137-x Ilknur Tugal-Tutkun Meri Urgancioglu Received: 19 April 2005 Revised: 22 August 2005 Accepted: 23 August 2005 Published online: 5 October 2005 # Springer-Verlag 2005 Bilateral acute depigmentation of the iris Abstract Purpose: To report on five cases of unusual bilateral stromal depigmentation of the iris and pigment dispersion masquerading as uveitis. Methods: We describe the clinical features of five consecutive patients who presented with acute depigmen- tation of the iris stroma between June and October 2003. Results: Four patients were female, one was male. Age at presentation ranged from 15 to 25 years. Presenting symptoms were sudden-onset ocular discomfort and red eye in four patients and change of eye color in one patient. All patients had bilateral involvement, with a symmetrical diffuse depigmentation of the iris stroma in three cases and patchy areas of iris depigmentation in two. Other common features were mild ciliary injection (seven eyes), Krukenberg spindle (seven eyes), circulating pigment in the anterior chamber (eight eyes), and heavy pig- ment deposition in the angle (ten eyes). No eyes had iris transillumina- tion defects, inflammatory keratic precipitates or inflammatory cells in the anterior chamber. Systemic labo- ratory work-up was unrewarding in all cases, and PCR analysis of the aque- ous humor for HSV1 and 2 was negative in one patient. Four patients were treated with a short course of topical corticosteroids and three with oral acyclovir. One patient was lost to follow-up. The remaining four patients were followed up for 6–19 months with a stable clinical picture. Conclusion: In contrast to pigment dispersion syndrome, pigment seemed to be released from iris stroma in the five cases described here. Although patchy depigmentation of the iris resembled the lesions seen in herpetic iridocyclitis in two of the patients, symmetrical bilateral involvement and lack of intraocular inflammation were the differentiating features. The patients described here could repre- sent a new entity or an unusual presentation of herpetic eye disease. Keywords Iris depigmentation . Pigment dispersion . Masquerading syndrome Introduction Atrophy and/or depigmentation of the iris is seen in a num- ber of inflammatory and noninflammatory conditions, including viral iridocyclitis, Fuchs’ uveitis syndrome, Vogt– Koyanagi–Harada disease, Horner’ s syndrome, acute angle- closure glaucoma, trauma, and pigment dispersion syndrome. In this report we describe five patients who presented in the summer of 2003 with an acute bilateral depigmentation of the iris stroma and pigment dispersion in the anterior chamber. The patients had a constellation of findings distinct from other known entities. Presented at the American Uveitis Society Meeting, Ft. Lauderdale, Florida, 24 April 2004. I. Tugal-Tutkun (*) . M. Urgancioglu Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey e-mail: itutkun@istanbul.edu.tr Tel.: +90-532-4141606 Fax: +90-216-4747378