Stage 5 is considered the end stage and is marked by maculopathy of more than two years and disciform scarring. . Make the diagnosis via the history and clinical observation. Patient education along with Amsler grid and home monitoring of visual acuity help uncover reactivated or macular disease. Early asymptomatic active retinal lesions are sometimes treated with oral or depot injections of steroids to reduce inflammation and the risk of macular disease. This is controversial given a lack of firm evidence that steroid or antifungal therapies are beneficial.
Numerous studies demonstrate the benefit of photocoagulation in cases with macular involvement.
The differential diagnosis of POHS includes both inflammatory and noninflammatory chorioretinal diseases. Consider diagnoses such as angioid streaks, toxoplasmosis, toxocariasis, recurrent multifocal choroiditis, birdshot choroiditis, punctate inner choroidopathy, acute posterior multifocal placoid pigment epitheliopathy, serpiginous choroidopathy and diffuse unilateral subacute neuroretinitis. Patients who have POHS frequently have a history of exposure to pigeons or chickens. It is frequently thought that avian fecal matter is a vector of spreading disease.