White/yellow flat macular lesion/pigment change DD

• Posttraumatic - pigmentary disturbance; cysts or hole at macula
• Postinflammatory - chorioretinal atrophy with pigment clumping at center and periphery of lesion
• Coloboma of macula-atrophic area at macula often associated with coloboma of disc; sclera may be ectatic (see p. 450)
• Radiation injuries-common after solar eclipse; punched-out appearance
• Fuchs dark spot-pigmented spot associated with other signs of degenerative myopia
• Drugs, including the following:
  adrenal cortex injection, aldosteroneallopurinol (?), amodiaquine, betamethasone (?), chloroquinecortisone (?), desoxycorticosterone (?), dexamethasone (?), diiodohydroxyquin, fludrocortisonefluprednisolone (?), griseofulvinhydrocortisone (?), hydroxychloroquine, indomethacin (?), iodochlorhydroxyquin, methylprednisolone, oral contraceptives, paramethasone (?), prednisolone (?), prednisone (?), quininetriamcinolone
• Stellate retinopathy - star-shaped exudates
• Hard exudates and circinate retinopathy
• Drusen – common, discrete yellow spots beneath the retina
• Doyne honeycomb choroiditis-rare; honeycomb pattern of yellow patches at posterior pole; degenerative changes at macula
• Heredomacular dystrophies:
• Best disease (vitelliruptive macular dystrophy) up to 18 years of age; egg-yolk lesion at macula, later absorbed to leave atrophic scar
• Fundus flavimaculatus - yellow patches at posterior pole; degenerative changes at macula
• Stargardt disease (juvenile macular degeneration) to 10 years of age; variable appearance in different families; bilateral lesions showing some degree of symmetry
• Behr disease (optic atrophy-ataxia syndrome) – adults, similar to Stargardt type
• Presenile and senile-pigmentary changes followed by atrophy, bilateral and symmetric
• Central choroidal sclerosis - rare, atrophic retina with sclerosed choroidal vessels showing clearly
• Central areolar choroidal atrophy-rare, exudate and edema followed by sharply defined atrophic area with white strands of choroidal vessels
• Pseudoinflammatory macular dystrophy-rare, initially edema and exudates followed by scarring with pigmentary disturbance and atrophic patches
• Gaucher disease (glucocerebroside storage disease)-rare, ring-shaped macular lesions, lipid deposits in cornea and conjunctiva
• Diffuse leukoencephalopathy - rare, white deposits in periphery and macular area
• Sjögren-Larsson syndrome (oligophrenia-ichthyosis-spastic diplegia syndrome)
• Angioid streaks
• Multiple evanescent white-dot syndrome (MEWDS) usually unilateral, predominantly healthy women, vitreitis
• Acute multifocal placoid pigment epitheliopathy – rare, map-like pigmentary disturbance of posterior pole or more widespread over posterior fundus