Vitiligo Iridis

A 75-year-old man presented with a diminution of vision in both eyes. On examination, pitted scar marks were noted all over his face. Ocular examination revealed bilateral senile cataract with multifocal small whitish punched-out areas of iris atrophy, scattered over the iris surface in both eyes [Arrows, Figure 1]. History was consistent with an episode of remote smallpox infection in childhood. A diagnosis of “vitiligo iridis” was made. Although smallpox was eradicated back in 1979, a large number of people infected before 1980 are still surviving and approaching eye care facilities for age-related ocular conditions like cataract. Vitiligo iridis refers to circumscribed effacing of the iris pigment, resulting in rounded white spots on its anterior surface resulting as sequelae of the Variola (smallpox) virus infection.[1] This condition may be unilateral or bilateral and may be associated with elevated intraocular pressure secondary to trabecular meshwork damage and pigment-induced secondary open-angle glaucoma.[2] Hence, a complete evaluation for glaucoma is essential in these patients. Similar appearances are noted in conditions like xeroderma pigmentosum, tuberculous iridocyclitis, and herpes zoster ophthalmicus. The image shows a slit lamp examination of the patient’s right eye showing whitish atrophic spots on the iris surface [Figure 1].Figure 1: Slit-lamp image of the patient’s right eye showing multiple punched-out white circular spots on the anterior surface of the iris (marked in black arrows)Declaration of patient consent The author (myself) certify that I have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.