In Vogt-Koyanagi-Harada (VKH) disease, the sunset glow fundus appearance develops due to:

• A Retinal pigment epithelium hyperplasia after resolution of subretinal fluid
• B Choroidal neovascular membrane formation beneath the macula
• C Depigmentation of the RPE and choroid following immune-mediated melanocyte destruction ✓
• D Disc pallor from optic atrophy following papillitis

Explanation

Sunset glow fundus in chronic/convalescent VKH results from immune-mediated destruction of uveal melanocytes (the disease targets melanin-containing cells throughout the body — uvea, meninges, inner ear, skin), leading to diffuse choroidal and RPE depigmentation. The resulting orange-red fundal glow reflects increased visibility of the underlying choroidal vasculature through the depigmented layers. This same mechanism explains the extraocular features: alopecia, poliosis, vitiligo, and dysacusis.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.