A 33-year-old male patient presented to the outpatient clinic for a routine eye examination. His medical and family history were unremarkable. Best-corrected visual acuity was 20/20 in both eyes, and intraocular pressures were within normal limits. Anterior segment examinations of both eyes were also unremarkable.
Fundus examination of the right eye exhibited multiple, well-demarcated, flat, variably-sized, hyperpigmented greyish-black RPE lesions with scalloped margins resembling bear footprints. On the contrary, the left eye was completely normal.
Congenital hypertrophy of the retinal pigment epithelium (CHRPE) is a benign, flat, pigmented lesion of the retinal pigment epithelium, often discovered incidentally during routine fundus examinations. In some individuals, multiple small CHRPE lesions cluster in one or both eyes, typically in the peripheral retina, and resemble the footprint of a bear—hence the term “bear tracks.” These lesions are usually well-circumscribed, round or oval, uniformly pigmented, and asymptomatic. They are typically unilateral and non-progressive, requiring no treatment. However, the presence of bilateral, multiple, and atypically shaped CHRPE lesions may be associated with familial adenomatous polyposis and warrants systemic evaluation.
