Bilateral betrayal: When imaging calls out Vogt–Koyanagi–Harada’s one-eyed act

We report a case of asymmetric Vogt-Koyanagi-Harada syndrome mimicking unilateral Central Serous Chorioretinopathy. This case highlights the diagnostic challenge for making a correct diagnosis between asymmetric Vogt-Koyanagi-Harada disease and Central Serous Chorioretinopathy with the help of multimodal imaging for early and accurate diagnosis to guide prompt treatment. We present a case of a 46-year-old female with sudden, progressive, painless blurring of vision in the right eye for five days. Examination revealed poor visual acuity in the right eye with normal anterior segments in both eyes. Fundus examination showed subretinal yellow lesions with multifocal exudative retinal detachments in the right eye and subtle peripheral lesions in the left eye. Optical Coherence Tomography revealed choroidal thickening, subretinal fluid, and fibrinous septa in the right eye. Fundus Flouresceine Angiography demonstrated delayed choroidal filling in both the eyes while multiple pinpoint hyperfluorescent leaks in right eye only, confirming bilateral Vogt-Koyanagi-Harada disease. Laboratory investigations were normal except for elevated erythrocyte sedimentation rate. The patient was treated with high-dose systemic corticosteroids, resulting in significant visual improvement and resolution of subretinal fluid. It is not uncommon for VKH to have asymmetric onset, so patient counseling and comprehensive approach is of utmost importance.