Ocular Histoplasmosis: Significance of Asymptomatic Macular Scars

During evaluation for active disciform macular disease of presumed ocular histoplasmosis in one eye, 12 patients were observed to have small inactive asymptomatic macular scars in the fellow eye. Activity later developed around these scars. Risk of development of the macular disciform syndrome in the second eye of histoplasmosis patients with prior activity in the first eye seems to be related to the presence of small asymptomatic scars in the macula of the second eye. If no scars or angiographic changes are present in the second eye, there seems to be less chance of developing an active lesion. If small atrophic scars are present, the chances of a future disciform syndrome may be increased. Careful follow-up and prompt detection and treatment of early activity will usually result in a better prognosis.