Congenital Hypertrophy of Retinal Pigment Epithelium (CHRPE)
 

There is a round, well-circumscribed pigmented lesion. There are depigmented halos within the lesion. Rarely, there are multiple pigmented lesions in the same area (bear-track lesions). Learn to differentiate CHRPE from choroidal naevus. Other signs: In bear-track lesions, the patient may have colostomy for familial polyposis coli.

Questions:

1. What is the significance of congenital retinal pigment epithelium hypertrophy?

Answer
Clinically they are asymptomatic although careful plotting of the visual field may show absolute scotoma corresponding to the lesion.
Patients with bilateral multiple lesions may have Gardner's syndrome which is associated with familial polyposis and bony tumours.

 

2. How do you differentiate CHRPE from choroidal naevus?

Answer
Edge of the lesion: CHRPE has more distinct border than choroidal naevus
Colour of the lesion: CHRPE is darker than choroidal naevus (typically naevus is brownish whereas CHRPE is black)
Visual field: CHRPE gives absolute scotoma whereas choroidal naevus does not affect the field
Malignant potential: CHRPE has no malignant potential whereas naevus may transform into malignant melanoma.

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Bear track lesions return to the top

 
 
 

choroidal naevus with paler colour and less distinct edge than CHRPE

CHRPE with darker colour and well-defined edges and central halos return to the top