ACUTE ZONAL OCCULT OUTER RETINOPATHY (AZOOR) ASSOCIATED WITH MULTIFOCAL CHOROIDOPATHY

Acute zonal occult outer retinopathy (AZOOR) may be precipitated by va rious retinal disorders and is characterised by rapid los of visual fi eld which cannot be explained by theophthalmoscopic changes conseqnent upon the initiating disease. The electroretinogram is abnormal, indic ating that the field loss is due to retinal dysfunction. The phenomeno n was first recognised in the multiple evanescent white dot syndrome ( MEWDS) as the enlarged blind spot syndrome. It was subsequently descri bed with multifocal inner choroidopathy and acute macular neuropaty (A MN). We have identified 7 patients who presented with widespread visua l loss associated with multifocal inner choroidopathy in whom function al loss was documented with electroretinography and automated visual f ield tsting. All patients were young, myopic, and othersise healthy wo men. Initial photopsia was noted by 4 patients. Fundus findings includ ed scattered small partially pigmented yellowish lesions resembling th ose in multifocal inner choroidopathy or pseudo presumed ocular histop lasmosis syndrome, disc swelling, vitritis, and secondary choroidal ne ovascularisation. Two patients had bilateral involvement. all patients had an enlargement of the blind spot, and widespread visual field los s which was not explained by fundus changes. All had an abnormal elect roretinogram suggeting widespread retinal disease. In AZOOR retinal dy sfunction occurs without corresponding visible retinal lesions. This d isorder appears to be precipitated by several conditions, although the causal relationship between the initiating event and the widespread f unctional loss is unknown.