retinitis pigmentosa

Retinitis pigmentosa showing the typical bone spicules pigmentary changes.

There are multiple bone-spicules hyperpigmentation in the peripheral retina. In advanced cases,  the posterior pole is also involved. The retinal vessels are attenuated and the optic disc is pale.  The macula may show cellophane, atrophic or cystoid maculopathy. The condition is bilateral.Other features to look for: drusen in the optic disc cells in the vitreous cataract typically posterior subcapsular cataract keratoconus  trabeculectomy (3% of  RP develop glaucoma) Look for associated features which may provide clue to diagnosis: hearing aids (Usher's syndrome but beware that patients with syphilis or congenital rubella  may also have deafness and pigmentary changes in the retina)