Choroiditis: types
Last reviewed: 23.04.2024
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Multifocal choroiditis and panoveitis
The symptoms of multifocal choroiditis and panoveitis are similar to those described above in the syndrome of ocular histoplasmosis. It also includes chorioretinal foci of atrophy, peripapillary scars, choroidal neovascularization, and linear margins on the periphery. However, the main difference is that with multifocal choroiditis and panoveitis, recurrent signs of the inflammatory process and the emergence of new foci of chorioretinal atrophy, more numerous and smaller, are noted, as well as the appearance of foci of inflammation in the anterior and posterior parts of the vitreous, inflammatory changes in the anterior chamber . The disc of the optic nerve is swollen. In the acute phase of the disease, there may be a local exudative retinal detachment. In patients with a long-term disease on the fundus, inflammatory foci in different stages of development can be identified.
Visual acuity reduced. With perimetry, note the expansion of the blind spot, individual scotoma in the field of view. In the process of treatment, it is possible to improve the visual fields.
Etiology is not established, although the infectious and autoimmune nature of the disease is not excluded.
In the acute phase and with the development of complications of the disease, treatment with corticosteroids is possible. Cases of self-healing are noted even in the presence of choroidal neovascularization.
Tuberculous choroiditis
Tuberculous choroiditis develops at a young age against the background of primary tuberculosis. The cause of the disease are mycobacteria, which infect many organs.
With tuberculosis lesions of the choroid, a miliary and multifocal choroiditis is more often observed. Choroidal tubercles are yellowish or grayish white in color. After treatment one or many chorioretinal scars with distinct edges, hyperfluorescent at FAH, are preserved. Tuberculosis-metastatic granulomatous chorioretinitis is characterized by a severe course with haemorrhages in the retina and infiltration of the vitreous. Tuberculosis-allergic chorioretinitis in the absence of mycobacterium tuberculosis in the eye proceed as non-granulomatous inflammation. They do not have clinical features, they often develop in children and adolescents during the period of tubular tests.
Differential diagnosis is performed with other granulomatous infections: sarcoidosis, brucellosis, leprosy, toxoplasmosis, syphilis, fungal infection. With tuberculous choroiditis, the nature of histological changes depends on the stage of the tuberculosis process. In primary tuberculosis, inflammation in the choroid occurs with diffuse lymphoid infiltration, the presence of epithelioid and giant cells. With secondary tuberculosis, a productive type of inflammation predominates, characterized by the formation of typical tuberculous granulomas with caseous necrosis.
Diagnosis is based on the detection of the out-of-focus foci of tuberculosis, the positive results of tuberculin samples and focal reactions of the eyes to the introduction of tuberculin.
Specific systemic treatment includes standard antituberculous therapy and antimycobacterial drugs (isoniazid, rifampicin, pyrazinamide, ethambutol, etc.). It is possible to use corticosteroids depending on the patient's immunological status and the course of the process. With tuberculosis-allergic chorioretinitis, local and general non-specific anti-inflammatory and desensitizing therapy is performed.
Toxocarous choroiditis
Toxocarous choroiditis is caused by the larval form of Toxocara canis, a helminth from the group of ascarids.
Ophthalmotoksokaroz can be a manifestation of a common disease with massive invasion of the body by larvae or the only clinical manifestation of helminthiosis.
The focus of granulomatous inflammation is formed around the larva at the site of its penetration into the eye. When the eye enters the eye through the vessels of the optic nerve disc, the larva tends to settle in the paramacular zone. After elimination of inflammation in the region of the posterior pole of the eye, a granuloma is formed. In younger children, the process proceeds more acutely with a massive inflammatory response of the vitreous, according to clinical manifestations, resembling retinoblastoma or endophthalmitis. In older children, adolescents, and adults, the process proceeds more benignly, with the formation of a dense proinitory focus in the parapapillary region. When a larva enters the eye, a peripheral granuloma forms along the system of the anterior ciliary arteries. In this case, the process can proceed almost asymptomatically.
In the acute phase of toxo-carious uveitis, the focus looks like a cloudy, whitish, strongly suggestive focus with perifocal inflammation and exudate in the vitreous. Subsequently, the hearth thickens, its boundaries become clear, the surface - shiny. Sometimes it defines a dark center as evidence of the presence of larval remains. The hearth is often associated with a fibrous stitch from the DZN.
Diagnosis is based on a typical ophthalmoscopic pattern and the detection of toxocarotic infection by enzyme immunoassay.
Treatment is often symptomatic, since antiparasitic drugs have little effect on larval forms of helminths. In addition, the process of inflammation often begins after the death and decay of the larvae due to their toxic effect on the surrounding tissues. Additional means of treatment are delimiting laser coagulation and surgical removal of granuloma along with the adjacent scar tissue.
Candidiasis choroiditis
Candidiasis choroiditis is caused by Candida albicans fungi. In recent years, the incidence of the disease is increasing due to the widespread use of antibiotics and immunosuppressant drugs.
Patients complain of decreased vision and floating opacities before the eye. Ophthalmoscopically, the process resembles toxoplasmosis. On the fundus there are found out the dominant yellow-white foci with fuzzy boundaries of different sizes - from small, like cotton wool, to foci of several diameters in the optic disc. Primarily affects the retina, as the process progresses, the process extends to the vitreous body and the choroid.
Diagnosis is based on a characteristic history (long-term use of large doses of antibiotics or steroid drugs) and results of a blood test during the period of candidaemia.
Treatment - local and systemic use of antifungal drugs (amphotericin B, oreungal, rifamin, etc.), which are introduced into the vitreous. In severe cases vitrectomy is performed - removal of the vitreous body.
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Syphilitic chorioretinitis
Syphilitic chorioretinitis can develop both in congenital and acquired syphilis.
Congenital changes in the retina are multiple small pigmented and non-pigmented foci, giving the eye bottom the appearance of salt with pepper, or multiple larger atrophic foci in the choroid, more often on the periphery of the fundus. Less frequent are peripapillary atrophic changes in the retina and choroid in combination with its peripheral dystrophic changes.
With acquired syphilis, retina and vascular disease develop in the second and third periods of the disease and proceed in the form of focal or diffuse chorioretinitis. Clinically, syphilitic chorioretinitis is difficult to distinguish from the processes of another etiology. To diagnose it is necessary to use serological reactions and take into account the characteristic changes in other organs.
Differential diagnosis in congenital syphilis should be carried out with secondary dystrophies of another origin (for example, rubella retinopathy), as well as hereditary retinal dystrophies. In case of differential diagnosis with hereditary retinal dystrophies, family history and ERG are important: with pigment retinitis, it is not recorded, with chorioretinitis normal or subnormal.
Diagnosis is based on the results of a serological study that is conducted to identify a specific infection.
Treatment of syphilitic lesions of the eyes is carried out together with the venereologist.
Chorioretinitis in HIV infection
Chorioretinitis in HIV infection occurs in the form of superinfection on the background of pronounced immunity disorders. The most common direct cause of eye damage is cytomegalovirus. Characteristic signs of chorioretinitis in HIV infection are a significant prevalence of the lesion, necrotizing nature of inflammation, hemorrhagic syndrome.
Diagnosis is based on the characteristic clinical signs and the detection of HIV. The prognosis is poor. Antiviral and immunotropic drugs are used in the treatment.