Presumed Ocular Histoplasmosis Syndrome (POHS)

Multiple peripheral histo spots (chorioretinal scars) in presumed ocular histoplasmosis syndrome (POHS). 

  • Presumed fungal infection disease which is more prevalent in certain parts of the USA such as Ohio, Mississippi and Nebraska.
  • Also seen in Holland where fungal spores are not present in the soil.

Clinical features:

  • Symptoms:
    • Mostly asymptomatic
    • Various degree of visual impairment associated with macular involvement
  • Signs:
    • No vitritis
    • Tetrade:
      1. Atrophic choroidal scars that evolve into discrete, focal, punched-out choroidal lesions
      2. Peripheral streaks
      3. Peripapillary atrophy
      4. Choroidal neovascularization which may occur in the macular region and complicated with macular hemorrhagic detachment and fibrovascular membrane formation
  • Treatment should be considered in cases with significant visual disturbances.