To investigate the mechanism of bilateral central vision loss in a patient wit h graft-versus-host disease. Observational case report. A 43-year-old man wi th graft-versus-host disease developed acute painless progressive central visi on loss, first in the left eye and then in the right. The patient underwent slit -lamp biomicroscopy, indirect ophthalmoscopy, fluorescein angiography, visual f ield testing, full-field electroretinography, multifocal electroretinography, a nd testing for paraneoplastic antibodies. Fundus examination and fluorescein ang iography were unremarkable. Goldmann perimetry revealed enlarged blind spots wit h central scotomas bilaterally. An electroretinogram testing showed asymmetric r etinal dysfunction, consistent with acute zonal occult outer retinopathy. No par aneoplastic autoantibodies were detected. The patient continued to have asymmetr ic progressive vision loss that stabilized over the next 6 months. Graft-versus -host disease should be included in the autoimmune conditions associated with A ZOOR.
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