COVID-19-related bilateral acute de-pigmentation of iris with ocular hypertension

A 43-year-old male patient presented with acute blurring of vision in both eyes associated with photophobia, redness, and mild pain following coronavirus disease 2019 (Covid-19) infection. Clinical examination revealed extensive pigment dusting in the corneal endothelium and the trabecular meshwork with de-pigmentation bands in the iris periphery. The patient was managed empirically with topical anti-glaucoma medications for high intra-ocular pressure. The patient was prescribed systemic antibiotics including cephalosporins and amoxicillin for respiratory symptoms. A rare condition called bilateral acute de-pigmentation of iris (BADI) was suspected after ruling out common entities, for example, viral kerato-uveitis, pigment dispersion syndrome, and Fuchs iridocyclitis. Covid-19 infection and systemic antibiotics including cephalosporins have shown to cause BADI in the literature. The patient responded well with good outcome.