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Decrease in vision in the presence of CNVMs and/or subretinal hemorrhages
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SIGNS
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Typically bilateral but asymmetric
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Narrow, irregular, orange-red-brown-gray spoke-like streaks radiating from the peripapillary region of the optic nerve (High risk of CNVMs and subretinal hemorrhages)
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Focal areas of RPE atrophy
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Optic nerve drusen may be present
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WORK-UP
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Full eye exam with dilation | OCT | OCT-Angiography | Fundus autofluorescence | Fluorescein angiography | ICG | Fundus photos | Infrared photos
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TREATMENT
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Monitor. No treatment needed. Give Amsler grid. Wear eye protection (Higher risk of choroidal rupture from trauma).
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Refer to PCP to rule out associated systemic conditions
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If CNVM or subretinal hemorrhage is present, refer to retinal specialist for further evaluation and treatment (anti-VEGF treatment, etc.)
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Once retina/choroid is stable after treatment with no signs of active leakage, monitor every 6 months
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ADDITIONAL LAB | TESTS
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Depends on the suspected underlying etiology, but consider the following: Physical exam by internist | Skin biopsy | Hemoglobin electrophoresis | CBC with differential | Serum calcium | Serum phosphorus | Serum alkaline phosphatase
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ETIOLOGY
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Increase brittleness of Bruch’s membrane leads to crack-like breaks
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PEPSI” Main etiologies of angioid streaks
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P: Pseudoxanthoma Elasticum (most common) | E: Ehlers-Danlos | P: Paget’s Disease | S: Sickle Cell Disease | I: Idiopathic
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DIFFERENTIAL DX
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Lacquer cracks, Choroidal rupture, Presumed ocular histoplasmosis, Ocular toxoplasmosis
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