A 42-year-old man presents with recurrent episodes of blurred vision. Fundoscopy shows a well-demarcated map-like area of choroidal and retinal pigment epithelial atrophy centred on the optic disc, which has enlarged outward in a creeping, snake-like fashion since his last visit. Fluorescein angiography shows early hypofluorescence with late staining of the active edge. What is the most likely diagnosis?

• A Multiple evanescent white dot syndrome
• B Serpiginous choroidopathy ✓
• C Birdshot chorioretinopathy
• D Punctate inner choroidopathy

Explanation

Serpiginous choroidopathy is a chronic recurrent disease of the retinal pigment epithelium and choriocapillaris in which geographic peripapillary lesions extend centrifugally in a serpentine pattern, with fresh activity at the leading edge and old atrophic scar behind. MEWDS is self-limiting with multiple macular lesions in young women, birdshot gives scattered cream-coloured spots nasal to the disc, and punctate inner choroidopathy produces small macular lesions unrelated to the disc.

Reference: Kanski's Clinical Ophthalmology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.