This 65YO presented with 20/400 vision in the left eye. Optos imaging shows classic ocular histoplasmosis (OHS) peripapillary, macular, and peripheral chorioretinal scarring. A more close-up macular image from the Triton swept-source OCT shows a greenish macular neovascularization (MNV) with associated subretinal blood.
The OCT B-scan shows subretinal fluid and hyperreflective subretinal blood, which causes choroidal shadowing.
Learning Points:
Ocular histoplasmosis is caused by the Histoplasmosis capsulatum fungus, which is commonly found in soil contaminated by bird or bat droppings. It is found worldwide, but in the United States, it is most common in the Ohio-Mississippi River valleys.
The vast majority of people in endemic areas inhale the organism’s spores early in life, and only a few percent will develop asymptomatic chorioretinal scars. A small percentage of these will develop MNV later in life.
Originally described by Woods and Wahlen in 1959, the findings include the classic triad of peripapillary atrophy, peripheral multifocal punched-out scars, and a macular scar or neovascularization.
We like to add a fourth criterion: a quiet vitreous, since numerous inflammatory disorders can simulate ocular histoplasmosis.
