A case documenting distinct natural history of multizonal outer retinopathy and retinal pigment epitheliopathy (MORR) with longitudinal multi-modal documentation of progression.

Purpose: To describe the clinical and imaging characteristics of the acute progressive phase of a recently proposed clinical entity, Multizonal Outer Retinopathy and Retinal Pigment Epitheliopathy (MORR), a variant of Acute Zonal Occult Outer Retinopathy (AZOOR).

Methods: Single observational case report.

Results: We present the case of a 49-year-old myopic female with progressive outer retinopathy most consistent with a diagnosis of MORR. Through multimodal imaging and longitudinal follow-up, we delineate the clinical course and imaging findings of asymmetrical episodic progressive centrifugal extension of retinal pigment epithelial disturbance in both eyes, highlighting the features of an acute progressive episode not previously described.

Conclusions: Clinicians should be aware of the active clinical and multimodal imaging features of MORR and its distinction from other outer retinopathies due to its sight-threatening distinct clinical course, bilateral involvement with peripapillary lesions, and episodic progression into the macula. Additionally, we describe a "grass-fire" and "spot-fire" progression pattern during acute exacerbation, highlighting the need for vigilant monitoring and early intervention in MORR.