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Simultaneous presentation of multifocal choroiditis and acute zonal occult outer retinopathy in one eye

A 20-year-old healthy female patient with moderate myopia who had a bipolar disorder was referred to us by her primary ophthalmologist because of a 3-year history of photopsia and painless visual field loss in her right eye that had accelerated in the past 7 months. She had not been taking any medications except oral contraceptives.

The patient had been referred to a neuro-ophthalmologist 2 months before our visit.

Clinical examination of the right eye revealed a relative afferent pupillary defect and a dense temporal field defect that appeared to respect the vertical meridian, with some involvement of the fovea (figure 1). The retinal pigment epithelium (RPE) changes in the temporal fundus (figure 1) were interpreted as a demarcation line from an antecedent retinal detachment. At that time, the patient was found as having a right optic neuropathy. Subsequently, a magnetic resonance imaging of the brain was performed, which yielded an unremarkable result. The finding of an extensive inflammatory, infectious and haematologic laboratory workup was negative.



Figure 1 
(A) Composite photograph of the right fundus showing both punched-out chorioretinal lesions in the temporal periphery forming a curvilinear streak and peripapillary pigmentary alterations. (B) AF photograph of the right eye revealing RPE abnormalities surrounding the optic nerve. (C) The visual field of the right eye demonstrates a moderately dense temporal scotoma that respects the vertical meridian except in the parafoveal area where the scotoma extends slightly inferior to fixation. (D/E) FA of the right eye demonstrating staining of the temporal chorioretinal spots with some very subtle window defects surrounding the optic nerve.



Upon examination in our office, the patient's best corrected visual acuity was 20/30 in the right eye and 20/20 in the left eye. Intraocular pressure was 16 mm Hg bilaterally. A mild cellular reaction was seen in the anterior vitreous of the right eye. …