If bilateral CHRPE clusters are observed, what action is recommended?

• A. Urgent colonoscopy and refer to gastroenterologist for FAP dx
• B. Immediate laser therapy
• C. Start systemic steroids
• D. Do nothing

Answer: (A)

Bilateral CHRPE clusters signal a potential systemic condition, most notably familial adenomatous polyposis (FAP). FAP is caused by an APC gene mutation and carries a high risk of developing many colorectal polyps that can progress to cancer if not detected early. When such retinal clusters are seen in both eyes, it should prompt an immediate GI evaluation to look for FAP. The appropriate action is to arrange a colonoscopy with a gastroenterologist to assess for polyposis and confirm or rule out FAP, enabling early surveillance and management if needed. Laser therapy would address only the eye findings and does not mitigate colorectal cancer risk. Systemic steroids are not relevant to this ocular–GI association. Doing nothing would miss an important warning sign for a potentially life-threatening condition.