A 35-year-old woman presents with bilateral gradual visual blurring, chorioretinal lesions, and a 'sunset glow' fundus. She also has a history of poliosis (white eyelashes), vitiligo, and bilateral sudden onset of headaches with neck stiffness 6 months prior. The diagnosis is:
- A Sympathetic ophthalmia
- B Sarcoid panuveitis
- C Vogt-Koyanagi-Harada (VKH) disease ✓
- D Birdshot chorioretinopathy
Explanation
VKH disease is a T-cell-mediated autoimmune attack against melanocytes, producing bilateral granulomatous panuveitis, exudative retinal detachments (acute phase), and characteristic cutaneous/neurological signs: vitiligo, poliosis (white eyelashes/eyebrows/scalp hair), alopecia, and an initial meningitic phase (headache, meningismus, CSF pleocytosis). Sunset glow fundus (depigmented fundus with choroidal atrophy revealing orange-red choroid) is a chronic phase finding. Sympathetic ophthalmia follows penetrating ocular trauma or surgery to one eye and histologically shows Dalen-Fuchs nodules without the systemic signs. Sarcoid panuveitis lacks the meningitic phase and poliosis. Birdshot chorioretinopathy (HLA-A29 associated) shows creamy lesions but no systemic melanocytic findings.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.