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CHORIORETINAL INFLAMMATORY DISEASES - Infectious Causes

Results 1-8 of 8
   
Ocular Tuberculosis  
 

Ocular tuberculosis is an infection caused by Mycobacterium tuberculosis. It can manifest as a primary infection or affect the eye...

Ocular tuberculosis is an infection caused by Mycobacterium tuberculosis. It can manifest as a primary infection or affect the eye via the hematogenous pathway. About 1-2% occurs through systemic tuberculosis. It may be unilateral or bilateral and occurs in all age ranges.

Tuberculosis can affect any structure in the eye and typically presents as a granulomatous process with multifocal, light colored choroidal granulomas.

Clinically it manifests as uveitis with a varied clinical presentation, such as chronic iridocyclitis, focal or multifocal choroiditis, and pan-periphlebitis. There can also be exudative retinitis with venous dilatation, hemorrhages and numerous white or yellow superficial exudates. Diffuse choroiditis (the presence of white-yellowish tubers with a diameter of 1/6 to ½ the diameter of the papillae in the choroid) is rare.

Symptomatic disease is more commonly observed during reactivation of dormant lesions than during the initial infection.

Tubercular serpiginouslike choroiditis frequently affects young to middle-aged patients. The most common presentation is the appearance of multifocal lesions of choroiditis in the posterior pole and periphery that expand centrifugally and later coalesce in a serpiginoid pattern. The active lesions are yellowish-white, which appear hypo-fluorescent in the early phase of fluorescein angiography and hyper-fluorescent in the late phase.

Ocular Toxocariasis  
 

Toxocariasis is an infectious parasitic disease caused by the larvae of the nematodes Toxocara canis and Toxocara cati, which are...

Toxocariasis is an infectious parasitic disease caused by the larvae of the nematodes Toxocara canis and Toxocara cati, which are worms inhabiting the intestines of their hosts. Toxocariasis is a worldwide infection and humans are incidental hosts in which aberrant infection occurs because the parasites cannot completely mature.

The usual mode of infection is eating contaminated soil (geophagia) via the hands, or uncooked food. Children who have close contact with dogs (puppies) are at great risk of infection.

The disease is typically unilateral and most often seen in children, though many cases in adults have been reported. Symptoms include decreased visual acuity but the initial clinical manifestation may be strabismus or leukocoria.

There are three main forms of ocular toxocariasis:

  • Peripheral granuloma
  • Posterior pole granuloma
  • Chronic endophthalmitis

The granuloma is usually yellowish white and 1-2 disc diameter in size, where the larva is encysted. A common finding is a radial fold of the retina extending from the perypheral granuloma to the optic disc. Vitritis may be mild to severe and patients may present with hypopyon.

Complications include macular heterotopia, epiretinal membranes, tractional retinal detachment, ciliary body detachment with hypotony, cataract, secondary glaucoma and phthisis bulbi.

The diagnosis is based on the clinical picture and serologic confirmation of specific IgG and IgM antibodies using ELISA. Other methods are detection of specific anti-toxocara IgG by Western-blot, specific IgE, and intraocular fluid PCR analysis. Patients with visceral larva migrans have leukocytosis and hypereosinophilia, while in patients with ocular toxocariasis they are usually absent.

Differential Diagnosis

  • Diseases with leukocoria:
  • Retinoblastoma
  • Coats’ disease
  • Retinopathy of prematurity
  • Persistent hyperplastic primary vitreous
  • Familial exudative vitreoretinopathy
  • Toxoplasmosis
  • Pars planitis
  • Endogenous endophthalmitis
Ocular Toxoplasmosis  
 

Toxoplasmosis is a common cause of intraocular inflammation and posterior uveitis in immunocompetent patients.

It predominantly affects children and young...

Toxoplasmosis is a common cause of intraocular inflammation and posterior uveitis in immunocompetent patients.

It predominantly affects children and young people (25-45 years of age) and is characterized by recurrences that can ultimately lead to significant visual loss.

In congenital toxoplasmosis, retinal involvement is characterized by the presence of a large, atrophic, excavated scar in the macula or elsewhere.

The acquired form is characterized by the presence of focal necrotizing retinitis with the involvement of inner retinal layers and overlying vitritis.

Differential Diagnosis

  • Acute retinal necrosis
  • Endophthalmitis
  • Foreign body
  • Fuchs’ heterochromic uveitis
  • Granulomatous anterior uveitis
  • Nongranulomatous anterior uveitis
  • Ocular manifestations of HIV
  • Ocular manifestations of syphilis
  • Retinitis
  • Sarcoidosis
  • Tuberculosis
  • Uveitic glaucoma
Ocular Manifestations of Syphilis  
 

Syphilis is an infectious disease caused by the spirochete Treponema pallidum. This disease can be classified into primary, secondary and...

Syphilis is an infectious disease caused by the spirochete Treponema pallidum. This disease can be classified into primary, secondary and tertiary forms. Ocular involvement may be present in all these forms, although the anterior segment is mainly affected in the secondary and tertiary forms.

The ocular manifestations of syphilis include interstitial keratitis, episcleritis, scleritis, iritis, chorioretinitis, optic neuritis, neuroretinitis, retinal vasculitis and even exudative retinal detachment. The anterior uveitis is unilateral in 65% of cases and can show iris rose spots.

The characteristic fundus findings are yellow placoid chorioretinal lesions in the posterior pole.

Ocular Manifestations of Measles Disease  
 

Measles is caused by a paramyxovirus that is highly contagious and is typically contracted in childhood. The most serious complications...

Measles is caused by a paramyxovirus that is highly contagious and is typically contracted in childhood. The most serious complications include corneal clouding and blindness, encephalitis, severe diarrhea and related dehydration, ear infections, and pneumonia.

The most common ocular manifestations of acquired meales infection are a self-limited keratitis or conjunctivitis in the early stages of infection, but retinopathy can occur. During the acute stages of retinal involvement, the fundus vessels may appear attenuated and can present optic disc swelling, small hemorrhages, and stellate macular lesions. Retinal findings include macular edema, pigment epithelial abnormalities, choroiditis, whitish retinal infiltrates, serous macular detachments, areas of retinal depigmentation, and optic neuritis.

Congenital infections can occur and the ocular manifestations include cataract and pigmentary retinopathy.

Measles and vitamin A deficiency together are a major cause of blindness among children in areas of the world where measles is common.

Differential Diagnosis

  • Central serous chorioretinopathy
  • Retinitis pigmentosa
  • Toxoplasmic retinochoroiditis
  • Vogt-Koyanagi-Harada disease
Lyme Disease  
 

Lyme disease is a systemic infection caused by Borrelia Burgdorferi and transmitted by the bite of a tick. The diagnosis...

Lyme disease is a systemic infection caused by Borrelia Burgdorferi and transmitted by the bite of a tick. The diagnosis is based on clinical findings and on serological study.

The disease presents three phases: phase I, characterized by chronic erythema migrans; phase II, by neurologic involvement; and phase III is characterized by chronic neurologic syndromes.

The ocular manifestations of Lyme disease may involve any portion of the eye and vary depending on the stage of the untreated disease. In early stage the patient may present conjunctivitis and photophobia. In mid-stage, blurred vision may also exist secondary to papilledema, optic atrophy, and optic or retrobulbar neuritis. Late stage may include iritis, keratitis, vitreitis, multifocal choroiditis, posterior or intermediate uveitis, and optic neuritis.

Diffuse Unilateral Subacute Neuroretinitis  
 

Diffuse unilateral subacute neuroretinitis (DUSN) is a rare condition that occurs in healthy patients, mainly in children and young adults...

Diffuse unilateral subacute neuroretinitis (DUSN) is a rare condition that occurs in healthy patients, mainly in children and young adults and is due to the presence of a subretinal nematode: Baylisascaris procyonis, Ancylostoma caninum, and others.

Clinical findings include unilateral, indolent, diffuse pigmentary changes with gray-yellow outer retinal lesions that reflect the movement of the subretinal nematode.

The local inflammatory changes may be related to toxic effects or immunologic stimulation from excretory products of the larva or from release of unknown soluble tissue toxins.

In the acute phase, patients often present with decreased visual acuity, vitritis, papillitis, and crops of outer retinal lesions. Later in the course of the disease, slowly progressive RPE changes and optic atrophy may be observed, as well as narrowing of the retinal vessels.

After the worm is killed, visual acuity loss usually does not progress.

Differential Diagnosis:

  • Papilledema
  • Toxoplasmosis
  • Presumed ocular histoplasmosis syndrome
  • Multiple evanescent white dot syndrome
  • Sarcoidosis
Progressive Outer Retinal Necrosis  
 

The progressive outer retinal necrosis (PORN) syndrome is a clinical variant of necrotizing herpetic retinopathy in profoundly immunocompromised patients with...

The progressive outer retinal necrosis (PORN) syndrome is a clinical variant of necrotizing herpetic retinopathy in profoundly immunocompromised patients with a large percentage of those infected with advance AIDS (< 50 CD4 cells). It is characterized by multifocal, patchy, retinal opacification that starts in the posterior pole and spreads rapidly to involve the entire retina. Patients with PORN usually present rapid progression with minimal anterior chamber inflammation, with no vitritis or retinal vasculitis allowing this entity to be distinguished from acute retinal necrosis. Optic nerve involvement can also occur, presenting as a papillitis or neuroretinitis.

Despite aggressive therapy with antiviral drugs, prognosis is poor. The disease progression and/or recurrence are common and the majority of patients develop no light perception vision. Total retinal detachments are common.

Clinical symptoms include unilateral or sometimes bilateral decreased vision, floaters, and constriction of visual fields. There are no complaints of pain.

Differential Diagnoses:

  • Cytomegalovirus retinopathy
  • Acute retinal necrosis (ARN)