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Dec 11, - Channel icon on left side is missing white dot on the left side of the icon that shows the activity on the channel. If i have all read.
Table of contents
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- a blank / white spot on the map
Although there is nothing to see initially, hence the word occult in the name, as time goes by there is usually some degree of RPE depigmentation and bone spicule formation in the affected area, along with retinal atrophy see Figure 4. Indeed, retinitis pigmentosa is the main differential diagnosis in the later phase of AZOOR, as is cancer associated retinopathy and melanoma associated retinopathy in the early phase. This condition is similar to AZOOR in that patients present with an enlarged blind spot with photopsia but unlike AZOOR as the damage is only visible months or years after the episode has started, in the form of RPE change and retinal atrophy.
These dots are not fizzy in any way, although they do disappear without a trace. It is firstly useful to consider how this condition is similar to the others in the spectrum. It is usually unilateral, is associated with an RAPD and an enlarged blind spot on perimetric testing and patients report photopsia. Unlike the others, a prodromal viral illness is common, similar perhaps to APMPEE which is outside this grouping, and of course the pathognomonic evanescent white dots occur which are not present in the other conditions see Figure 6.
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These dots are smallish, around microns in size, white and again, as the name suggests now that we know what it means , they disappear. This is crucial for differentiation from other conditions that are non-evanescent, such as APMPEE, in which the lesions leave a scar. Slight posterior vitreous inflammation and periphlebitis can occur.
On red free illumination of the retina wedge shaped lesions around the fovea can occasionally be seen representing a defect in the nerve fibre layer. It is possible that the oral contraceptive pill or intravenous adrenergic based chorioretinal vasoconstriction may be potential causes, although this, as with many aspects of these conditions, is the subject of debate.
This is a bilateral inflammatory condition that, as with the spectrum described above, is most common in young myopic white women.
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New lesions are creamy yellow and are associated with inflammation in the form of vitreous cells and debris, cystoid macular oedema and periphlebitis. Older lesions form white punched out scars with pigmented edges and the peripapillary area is a common site for these scars, which usually measure a third to a full disc in diameter see Figure 7. If the peripapillary lesions are fresh then a swollen disc is seen, along with impaired colour vision. As the name suggests there is potential for anterior as well as posterior segment inflammation and treating this is paramount to achieving a good outcome.
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In some cases it is possible to stop the immunosuppression after a period of control, while in others the chronicity of the condition is such that this is not possible. If the condition is entirely inactive and is never found to be active the main differential diagnosis is presumed ocular histoplasmosis syndrome. If the lesions are few in number and are grouped around the fovea then patients are said to suffer from PIC, which is to all intents and purposes a subset of MCP.
The reason that there is very little, if any, vitritis is principally due to the numbers of lesions involved rather than it being a different disease entity. With this condition, due to the perifoveolar area being so directly affected principal causes of visual morbidity stem from lesions affecting the fovea directly, which can be treated with immunosuppression if caught in the acute phase, or development of a choroidal neovascular membrane, which can be treated with anti-VEGF agents in the usual way.
This is a subset of MCP in which there are numerous peripheral densely packed multifocal scars. Sarcoidosis is thought to be a cause of this and some authors suggest that sarcoidosis may indeed be an important aetiological factor in the conditions in the MCP spectrum.
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As PIC is a small localised variant of MCP, so progressive subretinal fibrosis and uveitis syndrome is its big bad cousin from another town. MCP can progress to a stage where a subretinal gliotic sheet forms, which slowly extends across the posterior pole and if left unchecked can and will eventually involve the fovea see Figure 8.
Aggressive immunosuppression is the order of the day but even then it is very difficult to stop the lesion extending. This condition is characterised by distorted central vision in young adults, typically after a viral infection. Examination reveals very small dark spots at the level of the outer retina, surrounded by a yellow or orange coloured halo. During the acute stage fluid may accumulate under the neurosensory retina. Over a few weeks this fluid disappears and permanent RPE scars are left behind.
White dot syndromes can be a terrifying minefield of acronyms for the ophthalmic registrar of seemingly endless conditions, but once order can be established the whole visage is much less terrifying. Remembering that out of the mishmash birdshot, serpiginous and APMPEE are distinct and those which remain can be grouped into one big box, albeit untidily, is a very good start indeed. Dividing is conquering.
It is interesting to postulate as to how a similar aetiology might be behind the white dot syndromes. Are they really a disease of white people or is it a huge reporting bias? Some roads have been laid and various geographical features suitable for some degree of navigation have been found, and while many explorers have documented these quite well, a modern day Lewis and Clarke expedition that joins it all up has yet to take place.
Jones N: Uveitis, Second Edition. JP Medical Publishers; London: This site uses cookies. By continuing to browse the site you are agreeing to our use of cookies. Read our Cookies Policy. Home Education Trainees White dot syndromes. Share This. The three distinct syndromes Birdshot retinochoroidopathy An old style shotgun loaded with birdshot pellets has a fairly wide distribution of spread that was intended to make up for the difficult to hit moving target that is a bird in flight.
Figure 1: Birdshot retinochoridopathy.
Figure 2: Serpiginous choroiditis. Acute posterior multifocal placoid pigment epitheliopathy APMPPE This is a condition of younger, again mainly white people, with an average age of onset of 26 years and a slight male preponderance of 1. Select your missing device, then choose Directions to open its location in Maps. Mark your device as lost Keep your information secure even if your device is missing. Choose your missing device. Scroll down to Mark As Lost and select Activate. Choose Continue, then enter your phone number if you want it to display on your missing device. Select Next. If you want, you can choose to enter a custom message asking the finder of your missing device to contact you.
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