Multimodal imaging of bilateral and symmetrical dark without pressure retinal lesions in a child

A girl in her early adolescence was referred to our paediatric clinic due to the presence of bilateral pigmented retinal lesions. The patient complained of photophobia. Best corrected visual acuity was 6/6 in either eye. Fundus examination revealed bilateral symmetrical hyperpigmented, flat, well demarcated lesions in the nasal mid-peripheral retina. Multimodal imaging was performed including retinography, fundus autofluorescence and optical coherence tomography (OCT). OCT showed typical hyporeflectivity of the outer retinal layers (ellipsoid zone and outer photoreceptors) at the transition area between the lesion and normal retina. A diagnosis of dark without pressure (DWP) lesion was made, and the patient was kept under observation. This case report describes bilateral and symmetrical DWP lesions in a paediatric setting associated with photophobia. It is important that clinicians are aware of this clinical entity in order to avoid unnecessary investigations and to reassure patients and their parents accordingly.