Differential diagnosis of white dot syndromes
| Sex age laterality | Precipitants onset duration prognosis | Symptoms | Examination | |
| Multiple evanescent white dot syndrome | F>M 3rd–6th decade Usually unilateral | Viral prodrome Quick onset Weeks/months Very good | Blurred vision Scotomata Photopsia Dyschromatopsia | Blind spot enlarged Multiple white dots, may coalesce, centred around macula and vascular arcades, granularity at fovea ±vitreous cells |
| Acute posterior multifocal placoid pigment epitheliopathy | M=F 3rd–4th decade Bilateral Good | ±viral prodrome Acute Weeks/months Good, may be left with mottling | Blurred vision Scotomata Photopsia | Yellow/white placoid lesions at posterior pole ±vitreous cells |
| Acute retinal pigment epitheliitis/Krill disease | M=F 2nd–4th decade Usually unilateral | ±viral prodrome Sudden Weeks–months Excellent; can recur | Reduced acuity Metamorphopsia Scotomata | Small dark hyperpigmented lesions ±few vitreous cells |
| Punctate inner choroiditis | F>M 3rd–4th decade Bilateral | None Sudden – Good; may develop chorioretinal scars, choroidal neovascularisation or subretinal fibrosis | Reduced central acuity Scotomata Photopsia | Grey/yellow round opacities at posterior pole No vitreous cells |
| Acute zonal occult outer retinopathy | F>M Young Bilateral | ±viral prodrome Sudden Chronic Good, but recurrent | Blurred vision Field defects Photopsia White vision | Normal/mottling/retinitis pigmentosa appearance ±vitreous cells |
| Multifocal choroiditis and panuveitis | F>M 3rd–7th decade Bilateral | ±viral prodrome Insidious Chronic Usually poor with scarring | Blurred vision Scotomata Photopsia floaters | Myopia 50% iritis, yellow/white lesions →punched out scars ±disc swelling |
| Birdshot retinochoroidopathy/vitiliginous chorioretinitis | F>M 5th–7th decade Bilateral | None Insidious Chronic Variable cystoid macular oedema can occur, rarely choroidal neovascularisation | Blurred vision Floaters Poor night/colour vision Photopsia | Cream-coloured lesions with patchy depigmentation, optic atrophy, disc swelling Moderate vitreous cells |
| Subretinal fibrosis and uveitis syndrome | F>M 2nd–4th decade Bilateral | None Acute Chronic | Reduced vision | Low vision Anterior chamber and vitreous inflammation |
| Serpiginous choroidopathy | M>F 4th–7th decade None Bilateral | None Variable Chronic | Blurred vision Central/paracentral Scotomata Photopsia | Geographic areas of grey/yellow discolouration in peripapillary/macula area ±mild vitreous cells |
Adapted from Crawford and Igboeli.15
F, female; M, male.