Posterior Segment
Retinal Astrocytic Hamartoma
Also known as: retinal astrocytic hamartoma, retinal astrocytoma, astrocytic hamartoma, mulberry lesion, tuberous sclerosis retina, retinal phakoma, white retinal lesion
Filed as: Routine
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
Retinal astrocytic hamartoma is a benign tumour arising from the glial cells of the retinal nerve fibre layer. It appears as a white, raised, rounded lesion with its own vessels. Early lesions are semi-translucent and they calcify over time, with little growth. It is most often linked to tuberous sclerosis complex, and rarely to neurofibromatosis type 1 (Wang 2026), but can be an isolated finding. The Centre for Eye Health chair-side reference names neurofibromatosis type 1 and tuberous sclerosis as its most common associations. The optometry role is to document and image it, review it routinely, refer if it progresses, and make sure a systemic association has been considered.
Recognition
Symptoms: what patients report
- Usually none; found at a routine examination.
- Vision is affected only if the lesion involves the macula or leaks.
- There may be a known diagnosis of tuberous sclerosis or neurofibromatosis.
Signs: what the examination shows
- A white, raised, rounded retinal lesion with intrinsic vessels, often near the disc.
- Early: flat and semi-translucent, easily missed. Later: nodular and calcified.
- OCT: the lesion arises from the inner retina; optically empty cystic spaces may sit within or beside it.
- Fundus autofluorescence: calcified areas are bright.
- More than one lesion, or lesions in both eyes, supports a systemic association.
What OptoGuide™ covers for retinal astrocytic hamartoma
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked New Zealand therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Optometry Australia — A Diagnostic Guide to Posterior Eye Disease, Chairside Reference Pack (Centre for Eye Health), Version 2.0, 2026: Hypo-Pigmented Posterior Lesions
- Wang TI et al. Retinal Astrocytic Hamartoma in a Child With Neurofibromatosis Type 1 Treated With Selumetinib. Pediatrics 2026 (most commonly associated with tuberous sclerosis complex; may rarely occur in NF1)