What are the other Names for this Condition? (Also known as/Synonyms)

• PIC (Punctate Inner Choroidopathy)

What is Punctate Inner Choroidopathy? (Definition/Background Information)

• Punctate Inner Choroidopathy (PIC) is defined as a rare type of eye condition that affects both the retina and choroid. It presents characteristic findings when examined under a fundoscope by a healthcare specialist. PIC falls into a category of disorders known as white dot syndromes
• Punctate Inner Choroidopathy results in signs and symptoms that include vision abnormalities, blurred vision, and blind spots affecting partial vision. It is generally observed in young and middle-aged women who have shortsightedness (myopia)
• The cause of Punctate Inner Choroidopathy is not well-known. However, it is believed to be associated with viral infection. Individuals with certain genetic make-up (HLA-DR2) may have a higher risk for PIC
• A healthcare provider can use various physical (eye) exams, blood tests, and imaging studies to diagnose Punctate Inner Choroidopathy. Upon diagnosis, treatment options, such as steroids or other medications, can be used to treat the condition
• The prognosis for Punctate Inner Choroidopathy depends on each individual's signs and symptoms. The prognosis is generally good, but the condition commonly recurs

Who gets Punctate Inner Choroidopathy? (Age and Sex Distribution)

• Punctate Inner Choroidopathy can present itself at any age, but is more likely to occur between the 3rd and 5th decade affecting young and middle-age adults
• Both males and females are affected, although a high female predominance is noted. Over 90% of the cases are seen to affect females
• Individuals of different racial and ethnic backgrounds can be affected and no predilection for any particular race or ethnicity is observed

What are the Risk Factors for Punctate Inner Choroidopathy? (Predisposing Factors)

The risk factors for Punctate Inner Choroidopathy may include:

• The presence of HLA-DR2 genetic make-up indicates an increased risk
• In rare cases, a family history of the condition is observed
• Viral infections caused by Epstein-Barr virus
• Young women between the ages of 18 to 40 years have a higher risk
• Myopia or nearsightedness

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Punctate Inner Choroidopathy? (Etiology)

• Punctate Inner Choroidopathy is a rare eye condition of unknown cause
• It may be the result of a viral infection caused by Epstein-Barr virus (EBV), but this is not conclusively proven yet
• Over 90% of PIC is observed in individuals with myopia (or near vision)
• Punctate Inner Choroidopathy is a type of white dot syndrome; white dot syndromes are a group of eye disorders that involve inflammation of the retina and choroid

What are the Signs and Symptoms of Punctate Inner Choroidopathy?

The signs and symptoms of Punctate Inner Choroidopathy may include:

• The condition is typically bilateral and both eyes are affected
• Small specks, called floaters, may be seen moving through one's field of vision
• Presence of blind spots, or scotoma, causing partial vision loss
• Light-sensitivity
• Photopsia or flashes of light sensation
• Reduced vision; blurred vision
• The signs and symptoms may be asymmetrical, which means that:
  • The combination of signs and symptoms in each eye may be different
  • The rate of progression of the signs and symptoms of each eye may be different
  • The severity of signs and symptoms may vary from eye to eye

How is Punctate Inner Choroidopathy Diagnosed?

A healthcare professional may diagnose Punctate Inner Choroidopathy using the following tests and procedures:

• Physical examination and analysis of previous medical history
• Eye examination by an eye specialist
• Fundoscopic (ophthalmoscopic) examination by an eye specialist, who examines the back part of the eye (or the fundus)
• Visual acuity test using a special and standardized test chart (Snellen chart)
• Visual field studies may help detect blind spots or scotoma
• Slit-lamp examination: Examination of the eye structure using a special instrument called a slit-lamp. In this procedure, the pupils are dilated and the internal eye structure is examined
• Tonometry: Measurement of intraocular pressure or eye fluid pressure, especially to detect conditions such as glaucoma
• Fundus fluorescein angiography (FFA): In this technique, the eye blood vessels are examined using a fluorescein dye
• Fundus autofluorescence (FAF) imaging: It is a diagnostic technique to examine the fundus of the eye using a fluorescent dye
• Indocyanine green (ICG) angiography: It is used to examine the blood vessels of the choroid using a dye, called indocyanine green, particularly to study the choroid
• B-scan ultrasonography: Special ultrasound scan of the eye through a non-invasive diagnostic tool, to assess health of the eye structures
• Electroretinogram (ERG): It is a technique to measure electrical activities in the retinal cells
• Optical coherence tomography (OCT) of eye: Radiological imaging technique to visualize the eye structure
• Blood tests that include:
  • To check for the presence of antibodies in blood
  • Blood culture for infections
  • Complete blood count (CBC) with differential
  • Erythrocyte sedimentation rate (ESR)
  • Testing to determine the presence of HLA-DR2 genetic make-up
• Other tests to determine any underlying condition causing Punctate Inner Choroidopathy

If individuals have other signs and symptoms, then the following tests may be performed:

• Chest X-rays
• Neuroimaging studies including MRI scan of brain
• Lumbar puncture: In this procedure, the cerebrospinal fluid is collected and analyzed

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Punctate Inner Choroidopathy?

Complications of Punctate Inner Choroidopathy may lead to vision abnormalities and may include:

• Choroidal neovascularization (CNV): An abnormal development of blood vessels in the choroid, which if left untreated can result in permanent loss of vision. It is seen in 50% of the individuals with PIC
• Retinal detachment: An eye condition wherein the retina gets separated from the eye structures that holds the retinal layers together
• Glaucoma: A condition that can cause blindness due to higher intraocular pressure
• Cataracts: When the lens of the eye becomes clouded and cause vision loss
• If left undiagnosed and/or untreated, the condition can lead to permanent blindness
• Kidney damage, high blood sugar, and high blood pressure due to steroid treatment
• Recurrent Punctate Inner Choroidopathy: In a majority, the condition is known to recur if it is not treated appropriately. With each recurrence, the signs and symptoms may get more severe

How is Punctate Inner Choroidopathy Treated?

Early diagnosis and treatment of Punctate Inner Choroidopathy is very crucial in preventing complications that may result in irreversible damage to the eye. The treatment of PIC may include the following measures:

• Oral corticosteroids are generally effective and may be given to control inflammation. Steroids may also be administered intravenously depending on the underlying cause
• Dark glasses may be prescribed for light-sensitivity
• Addressing underlying conditions that may be contributing to progression of the disorder
• If the underlying cause is unknown, then decreasing inflammation is the main step towards treating PIC
• If choroidal neovascularization is observed, then laser therapy may be helpful
• Treatment of myopia by using eye glasses or contact lenses; surgical corrections using laser or lens implants
• In case of recurrence that fails to get better with medication, surgery to treat the condition may be considered

It is important to note that steroids may not be used in all cases, since it can worsen the condition. A healthcare provider will provide the best treatment options based upon each individual’s specific circumstances.

How can Punctate Inner Choroidopathy be Prevented?

It may be difficult to prevent Punctate Inner Choroidopathy, but the risk for the condition may be lowered through the following measures:

• Avoiding contact with individuals who have infections
• Educating the individual and family members about the underlying cause and preventing the development of any modifiable risk factors associated with the underlying condition (if possible)
• Treating any underlying infections and immunologic conditions, as early as possible
• Maintaining long-term follow-up checkups to watch out for any recurrences

What is the Prognosis of Punctate Inner Choroidopathy? (Outcomes/Resolutions)

• The prognosis of Punctate Inner Choroidopathy generally varies between individuals. In many cases, the prognosis is generally good and the condition can get better on its own, even without treatment. But, recurrences are commonly seen
• Nevertheless, the prognosis depends upon the severity of the signs and symptoms and the individual’s response to treatment. Individuals with mild signs and symptoms have better prognosis than those with severe conditions

Additional and Relevant Useful Information for Punctate Inner Choroidopathy:

Please visit our Eye & Vision Health Center for more physician-approved health information:

http://www.dovemed.com/health-topics/vision-center/