A 20-year-old moderately myopic female with near normal visual acuity was referred to us for complaints of photopsia and painless visual field loss in her right eye for 3 years which had accelerated in the prior 7 months. A relative afferent pupillary defect, 1+ cells in the anterior vitreous, multiple round grayish-yellow punched out lesions in the temporal retinal periphery and a dense temporal field defect were noted in the right eye. Spectral domain optical coherence tomography (OCT) revealed photoreceptor outer segment abnormalities typical of acute zonal occult outer retinopathy (AZOOR). The dual diagnosis of multifocal choroiditis and panuveitis (MFP) and AZOOR was made. Treatment with a subtenon injection of triamcinolone in the affected eye as well as oral immunosuppression with mycophenolate mofetil was initiated.
This case demonstrates that AZOOR should be considered in the differential diagnosis of cases of progressive visual field loss with minimal funduscopic changes, particularly when associated with a history of photopsia. It also emphasizes that two different entities of the AZOOR-complex are possible in the same eye. The higher resolution of the spectral domain OCT versus time domain OCT can play an important role in the diagnosis of AZOOR-complex disorders.