Sir,

We are grateful to the Doctors Agrawal for their interest and comments on our paper. They comment that we have not stressed the fact that frosted branch angiitis (FBA) is ‘very rarely’ unilateral. In fact our extensive literature review found that 25% of ‘primary’ FBA cases are unilateral and that was stated in our paper.1

The association of localized ‘secondary’ FBA with other retinal vasculitides was commented upon and illustrated in our paper, although the possible association with ‘Indian’ Eales' disease (a form of retinal vasculitis extremely common in the subcontinent, and typically presenting with substantial perivascular exudate) is interesting. We have also witnessed substantial exudate in these patients, but rather like sarcoid phlebitis, it tends to have a distinct opacity to it in comparison with the translucent frosted appearance which we have illustrated in our paper. We therefore wonder whether this is truly the same phenomenon. Clearly, there are instances of retinal ischaemia and neovascularization in patients with a frosted branch appearance. Whether all such patients should be labelled as ‘Eales’ disease' is open to debate, as there appears to be little agreement on the diagnostic boundaries for that disease.

There is, clearly, clinical variability to FBA, and the possibility of ischaemic complications should be borne in mind, as for any patient with retinal vasculitis.