Angioid Streaks

Angioid Streaks
SYMPTOMS Typically asymptomatic
Decrease in vision in the presence of CNVMs and/or subretinal hemorrhages
SIGNS Typically bilateral but asymmetric
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)
Focal areas of RPE atrophy
Optic nerve drusen may be present
WORK-UP Full eye exam with dilation | OCT | OCT-Angiography | Fundus autofluorescence | Fluorescein angiography | ICG | Fundus photos | Infrared photos
TREATMENT Monitor. No treatment needed. Give Amsler grid. Wear eye protection (Higher risk of choroidal rupture from trauma).
Refer to PCP to rule out associated systemic conditions
If CNVM or subretinal hemorrhage is present, refer to retinal specialist for further evaluation and treatment (anti-VEGF treatment, etc.)
FOLLOW-UP Monitor in 6-12 months
Once retina/choroid is stable after treatment with no signs of active leakage, monitor every 6 months
ADDITIONAL LAB | TESTS 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
ETIOLOGY Increase brittleness of Bruch’s membrane leads to crack-like breaks
PEPSI” Main etiologies of angioid streaks
P: Pseudoxanthoma Elasticum (most common) | E: Ehlers-Danlos | P: Paget’s Disease | S: Sickle Cell Disease | I: Idiopathic
DIFFERENTIAL DX Lacquer cracks, Choroidal rupture, Presumed ocular histoplasmosis, Ocular toxoplasmosis