White dot syndromes in the era of multimodal imaging.

Abstract

White dot syndromes comprise a heterogeneous group of inflammatory chorioretinal disorders historically hampered by overlapping clinical presentations and inconsistent nomenclature. Recent advances in multimodal imaging have fundamentally reshaped our understanding of these entities, enabling precise localization of tissue injury and revealing distinct pathogenic signatures across the disease spectrum. In this review, we discuss the different non-infectious posterior uveitides, formerly called "white dot syndromes", organized according to the primary anatomical locus of inflammatory injury: photoreceptoritis, retinal pigment epitheliopathy, choriocapillaritis, and inner choroiditis. We also examine secondary entities, an increasingly recognized group of reactive inflammatory syndromes arising after disruption of outer retinal immune privilege in association with pre-existing retinal or choroidal disease. For each category, we review the multimodal imaging features that define disease localization, activity, and progression, and highlight their direct therapeutic and prognostic implications, guiding management from watchful observation to aggressive immunosuppression or targeted anti-angiogenic therapy.