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:
    • Atrophic choroidal scars that evolve into discrete, focal, punched-out choroidal lesions
    • Peripheral streaks
    • Peripapillary atrophy
    • 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.