Acute Zonal Occult Outer Retinopathy - AZOOR
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45-year-old man was seen in the office on 1-29-08. He had muscle surgery when he was a child for strabismus. He does not, to his knowledge, have any problem with amblyopia. He noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.
VISUAL ACUITY: OD: 20/20; OS: 20/40. IOP: OS: 16, OS: 15. Color vision: 8/10 correct in each eye.
Slit Lam Exam: Normal with clear lenses.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.2. There is no posterior vitreous separation. There is a nevus inferior to the fovea.
OS: Vertical C/D ratio is 0.1. There is 1+ vitreous cells. The optic nerve is pink. There are peripheral bone spicules extending from 9:00 around to 6:00 sparing the macula. Photos confirm clinical findings.
A fluorescein angiogram shows typical hyperfluorescence and window defects in the areas of the bone spicules, which are only present in the left eye and spare the macula, as you would expect in a patient with retinitis pigmentosa.
IMPRESSION:
1. PERIPHERAL BONE SPICULES IN THE LEFT EYE.
2. POSSIBLY UNILATERAL RETINITIS PIGMENTOSA.
3. PROBABLE ACUTE ZONAL OCCULT OUTER RETINOPATHY.
DISCUSSION: I explained to the patient that the signs in the left eye are consistent with retinitis pigmentosa, however this is typically a bilateral disease. There are reported cases in the literature of unilateral retinitis pigmentosa, but most of these pre-date the description of AZOOR, which has findings similar to that seen in retinitis pigmentosa. This patient’s eye is slightly different than most AZOOR eyes I have seen in that the
patches of bone spicules in the left eye are in the periphery as you would expect in patients with retinitis pigmentosa. It is interesting, though, that the inferonasal quadrant is spared in the left eye. The only infectious disease I ordered blood tests for is syphilis, to rule that out. I asked him to return here for a check in three to four months, sooner should he notice any problem, and to see you back periodically.
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Acute Zonal Occult Outer Retinopathy1351 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.
VISUAL ACUITY: OD: 20/20; OS: 20/40. 
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Acute Zonal Occult Outer Retinopathy1178 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.
VISUAL ACUITY: OD: 20/20; OS: 20/40.
(0 votes)
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Acute Zonal Occult Outer Retinopathy1011 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.
VISUAL ACUITY: OD: 20/20; OS: 20/40.
(0 votes)
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Acute Zonal Occult Outer Retinopathy1086 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.
VISUAL ACUITY: OD: 20/20; OS: 20/40.
(0 votes)
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Acute Zonal Occult Outer Retinopathy885 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.
VISUAL ACUITY: OD: 20/20; OS: 20/40.
(0 votes)
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Acute Zonal Occult Outer Retinopathy908 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.
VISUAL ACUITY: OD: 20/20; OS: 20/40.
(0 votes)
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Acute Zonal Occult Outer Retinopathy1142 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.
VISUAL ACUITY: OD: 20/20; OS: 20/40.
(0 votes)
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Acute Zonal Occult Outer Retinopathy939 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.
VISUAL ACUITY: OD: 20/20; OS: 20/40.
(0 votes)
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Acute Zonal Occult Outer Retinopathy862 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.
VISUAL ACUITY: OD: 20/20; OS: 20/40.
(0 votes)
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Acute Zonal Occult Outer Retinopathy1021 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.
VISUAL ACUITY: OD: 20/20; OS: 20/40.
(0 votes)
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Acute Zonal Occult Outer Retinopathy1084 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.
VISUAL ACUITY: OD: 20/20; OS: 20/40.
(0 votes)
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Acute Zonal Occult Outer Retinopathy1200 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.
VISUAL ACUITY: OD: 20/20; OS: 20/40.
(0 votes)
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Acute Zonal Occult Outer Retinopathy919 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.
VISUAL ACUITY: OD: 20/20; OS: 20/40.
(0 votes)
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Acute Zonal Occult Outer Retinopathy797 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.
VISUAL ACUITY: OD: 20/20; OS: 20/40.
(0 votes)
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Acute Zonal Occult Outer Retinopathy798 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.
VISUAL ACUITY: OD: 20/20; OS: 20/40.
(0 votes)
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Acute Zonal Occult Outer Retinopathy718 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.
VISUAL ACUITY: OD: 20/20; OS: 20/40.
(0 votes)
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Acute Zonal Occult Outer Retinopathy754 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.
VISUAL ACUITY: OD: 20/20; OS: 20/40.
(0 votes)
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Acute Zonal Occult Outer Retinopathy868 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.
VISUAL ACUITY: OD: 20/20; OS: 20/40.
(0 votes)
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Acute Zonal Occult Outer Retinopathy866 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.
VISUAL ACUITY: OD: 20/20; OS: 20/40.
(0 votes)
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Acute Zonal Occult Outer Retinopathy908 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.
VISUAL ACUITY: OD: 20/20; OS: 20/40.
(0 votes)
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Acute Zonal Occult Outer Retinopathy813 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.
VISUAL ACUITY: OD: 20/20; OS: 20/40.
(0 votes)
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Acute Zonal Occult Outer Retinopathy841 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.
VISUAL ACUITY: OD: 20/20; OS: 20/40.
(0 votes)
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Acute Zonal Occult Outer Retinopathy1011 views45-year-old man noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.
VISUAL ACUITY: OD: 20/20; OS: 20/40.
(0 votes)
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45-year-old man was seen in the office on 1-29-08. He had muscle surgery when he was a child for strabismus. He does not, to his knowledge, have any problem with amblyopia. He noticed a few years ago peripheral vision blurriness in the left eye and also some central vision loss. Previous to that, as far as he knows, the two eyes were okay.
VISUAL ACUITY: OD: 20/20; OS: 20/40. IOP: OS: 16, OS: 15. Color vision: 8/10 correct in each eye.
Slit Lam Exam: Normal with clear lenses.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.2. There is no posterior vitreous separation. There is a nevus inferior to the fovea.
OS: Vertical C/D ratio is 0.1. There is 1+ vitreous cells. The optic nerve is pink. There are peripheral bone spicules extending from 9:00 around to 6:00 sparing the macula. Photos confirm clinical findings.
A fluorescein angiogram shows typical hyperfluorescence and window defects in the areas of the bone spicules, which are only present in the left eye and spare the macula, as you would expect in a patient with retinitis pigmentosa.
IMPRESSION:
1. PERIPHERAL BONE SPICULES IN THE LEFT EYE.
2. POSSIBLY UNILATERAL RETINITIS PIGMENTOSA.
3. PROBABLE ACUTE ZONAL OCCULT OUTER RETINOPATHY.
DISCUSSION: I explained to the patient that the signs in the left eye are consistent with retinitis pigmentosa, however this is typically a bilateral disease. There are reported cases in the literature of unilateral retinitis pigmentosa, but most of these pre-date the description of AZOOR, which has findings similar to that seen in retinitis pigmentosa. This patient’s eye is slightly different than most AZOOR eyes I have seen in that the
patches of bone spicules in the left eye are in the periphery as you would expect in patients with retinitis pigmentosa. It is interesting, though, that the inferonasal quadrant is spared in the left eye. The only infectious disease I ordered blood tests for is syphilis, to rule that out. I asked him to return here for a check in three to four months, sooner should he notice any problem, and to see you back periodically.
