Urrets−Zavalia syndrome as a complication of ocular hypotonia due to intravenous cidofovir treatment

Sir,

We read the article written by Orssaud et al¹ published in your valuable journal.They reported a case of Urrets–Zavalia syndrome (UZS) after receiving intravenous cidofovir treatment for laryngotracheal papillomatosis. They reported that anterior uveitis was observed in both eyes and the authors prescribed topical steroid and topical atropine 1% twice a day. Despite discontinuation of topical atropine therapy, she developed UZS in the left eye. They related the fixed dilated pupil to ocular hypotonia. However, they used atropine for the treatment of anterior uveitis and the iatrogenic mydriasis is a more common reason for the UZS as described by Mocan et al² (although the other eye did not develop UZS). As they proposed, iris ischemia precipitated by iris dilation and strangulation of iris vessel and iatrogenic damage to the radial nerve fibers of the iris could result in UZS.