Some patients may initially present with macular involvement and no peripheral lesions. Cells often appear in both the vitreous and anterior chamber. Over weeks or months, the lesions evolve into atrophic scars with variable pigment hypertrophy and, usually, extensive atrophy of the RPE and choroid. Recurrent lesions often appear adjacent to old healed ones. During acute episodes, fluorescein shows early hypofluorescence and late staining in the acute lesion area.
Healed lesions appear as window defects, owing to the atrophic nature of the scars.
The ERG and EOG are usually normal. Choroidal neovascular membranes occur in up to a fourth of cases. If extrafoveal, they can be treated with laser. Some physicians have tried acyclovir, but the value of this is unclear. When there's macular involvement with decreased visual acuity, steroids appear to hasten resolution of the acute lesion and prevent recurrences.