Acute Zonal Occult Outer Retinopathy

Abstract

Acute zonal occult outer retinopathy (AZOOR) is a rare retinal disease, which is easily missed during its early stages. We report a case of a 31 year old male who          presented with acute onset scotoma associated with flashes of light within the scotoma in left eye since 3 weeks. He gave history of common cold 1 month back. His visual aquity was 6/6 in right eye & 6/6p in left eye. Fundus            findings were unremarkable in both eyes. HFA revealed temporal field defect in left eye. Prior visiting us, he had multiple neurophysician consultations where he was           diagnosed to be normal. OCT showed disruption of outer retinal layers around optic nerve head. Fundus                       autofluorescence (FAF)  showed hyperautofluorescence around the disc. ERG showed mild decrease in ‘a’ and ‘b’ wave amplitude. Re-evaluation of fundus revealed very subtle changes which were missed earlier. The patient was diagnosed as a case of AZOOR & started on oral steroids 1mg/kg/day. AZOOR is commonly missed due to normal clinical findings and rarity of the disease. In cases with scintillating scotoma with normal fundus, one should suspect AZOOR as a potential diagnosis.

 Keywords: AZOOR, Scintillating scotoma, OCT, FAF, ERG