Late-onset atypical acute zonal occult outer retinopathy following COVID-19 infection

Acute zonal occult outer retinopathy (AZOOR) is a rare outer retinal disorder that typically affects young myopic women and presents with acute visual field defects and photopsia. We report an atypical case of late-onset AZOOR in a late 50s man who presented with chronic, painless blurred vision with symptom onset temporally associated with prior COVID-19 infection. The patient was initially misdiagnosed with glaucoma due to elevated intraocular pressure and visual field abnormalities. Multimodal retinal imaging revealed a characteristic hyperautofluorescent ring on fundus autofluorescence and zonal ellipsoid zone loss on optical coherence tomography, with corresponding enlargement of the blind spot on automated perimetry. Visual acuity and colour vision were preserved, and no relative afferent pupillary defect was present. The visual field remained stable during follow-up. This case highlights the expanded clinical spectrum of AZOOR, underscores the importance of multimodal imaging in distinguishing AZOOR from glaucomatous optic neuropathy and raises awareness of possible post-infectious associations in atypical presentations.