Which of the following conditions is MOST likely associated with a macular exudative star?

• A. Optic disc drusen
• B. NAION
• C. Neuroretinitis
• D. Chorioretinitis

Answer: (C)

A macular exudative star appears when lipid-rich exudates spread in the outer retinal layers around the fovea due to inflammation and leakage from the optic nerve head, a pattern that is most characteristic of neuroretinitis. This condition is classically seen with Bartonella henselae infection (cat scratch disease), where optic disc edema accompanies the macular star.

Optic disc drusen are calcified drusen in the optic nerve head and don’t typically produce a macular star. NAION causes sudden painless vision loss from ischemia of the optic nerve and lacks this star exudation pattern. Chorioretinitis involves inflammation of the choroid and retina but does not characteristically present with a macular star.

So the macular exudative star is best associated with neuroretinitis.