Angioid Streaks - Peau D'Orange

Please see the Normal Fundus Photo first for comparison. This photo shows the finding called peau d'orange (orange skin) in the condition angioid streaks. The streaks emanating from the optic nerve in this case are evident. Look toward the east border of the photo and notice the pebbly orange appearance of the retina. This is the characteristic look of peau d'orange. Bruch's membrane, a connective tissue barrier under the retinal pigment epithelium, is abnormal. Similarly, the collagen of the skin is abnormal in patients who have angioid streaks in association with the systemic disease pseudoxanthoma elasticum. Not everyone with angioid streaks has pseudoxanthoma elasticum. Some have hemoglobinopathies or Paget's disease. Others have no discernible systemic disease. All patients with angioid streaks should be systemically examined, however, to look for systemic disease, as this may have management implications. For example, patients with pseudoxanthoma elasticum have a higher incidence of stroke, and may need to be on anti-platelet aggregates at an early age.