Retinal Inflammatory Disease 1271 Retinal Vasculitis Definition

Retinal vasculitis is an inflammation of the retinal vasculature. Typical findings include cells in the vitreous body.

Epidemiology: Retinal vasculitis is one of the more frequent clinical syndromes.

Etiology: The cause of retinal vasculitis often remains obscure. It can be caused by a pathogen or occur in association with immunologic processes (Table 12.8).

12.7 Retinal Inflammatory Disease Table 12.8 The most important causes of retinal vasculitis

❖ Idiopathic

❖ Behcet's disease

❖ Multiple sclerosis

❖ Lupus erythematosus

❖ Wegener's granulomatosis

❖ Polyarteritis nodosa

❖ Horton's arteritis

❖ Sarcoidosis

❖ Tuberculosis

❖ Borreliosis (Lyme disease)

❖ Listeriosis

❖ Brucellosis

Symptoms: Patients report loss of visual acuity or black dots in their visual field. These are due to the presence of cells in the vitreous body.

Diagnostic considerations: The ophthalmologic diagnostic work-up includes clinical examination, ophthalmoscopy, and slit-lamp examination. The slit-lamp examination will reveal cells in the vitreous body. Ophthalmoscopic findings will include whitish preretinal infiltrates (Fig. 12.33), vascular constriction (usually involving the veins), vascular occlusion, intraretinal bleeding, and retinal edema. Fluorescein angiography may be used to evaluate the presence and activity of neovascularization. Underlying systemic disease, immunologic processes, and infections (see Table 12.8) must be excluded.

Differential diagnosis: Other vascular diseases of the retina such as vein occlusion should be excluded. These vascular diseases may be distinguished from vascular retinitis by the absence of cells in the vitreous body.

Retinal vasculitis.

Retinal vasculitis.

Fig. 12.33 Ophthalmoscopy reveals whitish preretinal vitreous infiltrates (arrow).

Treatment: The causes of known underlying disorders should be treated. Symptoms are treated with topical steroids and systemic steroids in the absence of contraindications. Neovascularization is treated with laser therapy.

Prophylaxis: No prophylaxis is possible except for possible treatment of an underlying disorder.

Clinical course and prognosis: Vascular occlusion can result in neovasculari-zation that may lead to vitreous hemorrhage. Tractional retinal detachment is another possible complication.

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