White Dot Syndromes Flashcards
Worst prognosis
Serpiginous choroidopathy and multifocal chiroiditis and pan uveitis
APMPPE
Acute Posterior Multifocal Placoid Pigment Epitheliopathy
young healthy F=M
bilateral
good visual recovery
creamy yelllow-white plaque-like lesions that fade over 2-6 weeks
FA - early blockage with late hyperflorences or window defects
MEWDS
Mulitple evanescent white dot syndrome
F > M
young - 15-50 yo
unilateral > bilateral
white spots in posterior pole, optic disck swelling with + APD
FA - early hyperflourescence with late staning of lesions and ON
ERG with reduced A wave
can have incomplete visual recovery. 10% chance of recurrance or other eye involvement.
Serpiginous Choroidopathy
chronic, recurrent, indolent
F=M, 40-60 yo
bilateral
painless vision loss
geographic atrophy with active edges, started from ON/posterior pole, can have vitritis, AC reaction, NVD, CNV
Absolute scotoma where scars are present
TX - oral steroids or immunosuppresion
fair to poor prognosis, can recur
Birdshot Choroidopathy
F > M
40’s, bilateral
HLA-A29 (90%)
decresed vision, nyctalopia, decr color VA,
Cream colored spots throughout fundus, vitritis, mild AC reaction, vasculitis, optic atrophy, CME, ERM, CNV
FA - pronounced perifoveal capillary leakage (CME)
ERG - decresed scotopic response
Multifocal choroiditis with panuveitis
F > M
20-50 yo
gray-white lesions that become atrophic punched out lesions, AC and vitreous cell, can develop CME/CNV
FA - acute lesions with blockage or early fill, older lesions behave like window defects
Tx: steroids
PIC
Punctate inner choroidopathy
20-40 yo, myopic healthy
F > M
acute scotomas with small yellow or gray inner choroidal lesions that resolve over weeks to form atrophic scars, can have serous RD
NO VITRITIS or AC CELL
Krill’s Disease
Acute retinal pigment epithelitis
young adults
unilateral
sudden decrease in VA
cluster of huperpigmented spots surrounded by yellow-white halo
no vitritis
FA - blockage of spots with hyperflourescence of halos
resolves completely in 6-12 weeks
Frosted branch angiitis
secondary to CMV or toxoplasmosis (Kyrieleis’ plaques)
white spots along retinal vessels
Acute zonal Occult Outer Retinopathy
AZOOR
bilateral
F >M
photopsial with rapid loss of regions in VF
minimal change on exam initially, retinal pigmentary changes later
VF with scotomas
ERG with decreased rods and cons
Uveal effusion syndrome
middle-aged males
chronic, recurrent
complain of decreased VA, metamorphopsia, scotomas
serous retinal, choroidal, ciliary body detachment
mild vitritis, RPE leopard spots, conj injection
‘shifting subretinal fluid’
B-scan - thinkened sclera, serous RD, choroidal detachment
steroids not effective, tx - partial thickness scleral windows
Diseases with female predominance
MEWDS
Birdshot
Multifocal choroiditis with pan uveitis
PIC
Diseases with vitritis
APMPPE (mild)
MEWDS (Mild)
Serpiginous (mild)
Bridshot (moderate)
multifocal chrooiditis with pan uveitis (Moderate)
(NOT PIC!)
usually bilateral
Usually unilateral
APMPPE
serpginious
birdshot
MEWDS
Can be associated with CNV
serpginous (25%)
Mulitfocal choroiditis and panuveitis (35%)
PIC (40%)
Rare in APMPPE, MEWDS, Birdshot
