Retinitis: causes, symptoms, diagnosis, treatment

Retinitis is an inflammatory disease of the retina.

Infectious and inflammatory diseases of the retina are rarely isolated: they usually serve as a manifestation of a systemic disease. The choroid and retinal pigment epithelium are involved in the inflammatory process, as a result of which a characteristic ophthalmoscopic picture of the chorioretinitis is formed, and it is often difficult to determine where the inflammatory process primarily occurs in the retina or choroid. Diseases are caused by microbes, protozoa, parasites or viruses. The process can be common, disseminated (for example, syphilitic retinitis), localized in the central parts of the retina (central serous chorioretinitis) or near the optic nerve disk (Jensen's juxtapapillary chorioretinitis). The localization of the inflammatory process around the vessels is typical for the periphpleitis of the retinal veins and Illza disease.

Various etiological factors causing inflammatory changes in the posterior pole of the fundus cause multifocal involvement of the retina and choroid in the pathological process. Often the main role in diagnosis is played by the ophthalmoscopic picture of the fundus, as there are no specific diagnostic laboratory tests to identify the cause of the disease.

There are acute and chronic inflammatory processes in the retina. To establish the diagnosis is very important anamnestic data. Histologically, the division of the inflammatory process into acute and chronic inflammation is based on the type of inflammatory cells found in tissues or exudate. Acute inflammation is characterized by the presence of polymorphonuclear lymphocytes. Lymphocytes and plasma cells are detected in chronic non-granulomatous inflammation, and their presence indicates the involvement of the immune system in the pathological process. Activation of macrophages or epithelioid histiocytes and giant inflammatory cells is a sign of chronic granulomatous inflammation, so immunological studies are often the main ones not only in establishing the diagnosis, but also in choosing the tactics of treatment.

[1], [2]

Septic retinitis

Septic retinitis often occurs in patients with endocarditis, meningitis, in women after childbirth. At the basis of retinal changes in sepsis are inflammatory vascular lesions of the retina - perivasculitis.

Septic retinitis is indicative of the severity of the process and often occurs before a fatal outcome. It is caused by the introduction of bacteria and toxins into the vessels of the retina.

Septic retinitis Rota - the process is localized in the retina, Vision usually does not suffer. In the macular area around the disc, along the nipple - foci of exudate yellow-white, not merging, there are often hemorrhages in the form of a wreath with a white hearth in the middle. Periarteritis, periphlebitis are possible. In the outcome of the disease, foci may resolve. Septic retinitis may be the beginning of metastatic ophthalmia. Clinic - symptoms of irritation are noted, more in adult patients, the color of the cornea changes. On the fundus there are plural white foci, located close to the vessels. Foci in the macular area are often formed in the form of a star. Symptoms grow, the edema of the optic nerve disc develops, the opacity of the retinal vessels is noted, the vitreous body dims, its purulent melting leads to endophthalmitis, and then to panophthalmitis.

Viral retinitis

Viral retinovascular (pathogens - herpes simplex, herpes zoster, adenoviruses, influenza virus). Changes in the retina with influenza are observed frequently. In various degrees, the transparency of the retina is disturbed: from gentle diffuse opacification to the formation of saturated white spots of various shapes and sizes. The turbid portions of the retina have a "cotton-like" appearance and are located mainly around the optic nerve disk and in the macular area. Vessels passing here are veiled or not visible at all. The clouding of the retina is due to swelling or clouding of the interstitial substance. The function of the clouded part of the retina is broken, although the viability of the cells is reduced. The clinical picture is characterized by considerable variability in time. White spots gradually become smaller, more transparent, and finally disappear completely or almost completely. As the transparency of the retina is restored, its function is restored. The course of recurrent, often occurs exudative detachment of the retina.

The prognosis for sight is unfavorable. Sometimes after the flu can develop a picture of pigmentary degeneration of the retina.

Tuberculous retinitis

Tuberculosis retinitis - with the introduction of a specific infection, the vascular wall suffers. Isolated retinitis is rare.

Forms of tuberculous retinitis:

1. a billion tuberculosis retinitis;
2. solitary retinal tuberculosis;
3. exudative retinitis without specific pattern;
4. tubercular retinal lesions;
5. tubercular retinal arthritis.
6. ) miliary tuberculosis retinitis (currently not found). With this pathology, a number of foci of a whitish-yellowish color appear mainly along the periphery of the retina;
7. Solitary retinal tuberculosis is usually observed in young people, in children. One eye is affected. This is the fusion of several granulomas that are localized in the center of the optic nerve disk, on the periphery (where the blood supply suffers). The specific granuloma has a rounded shape, is near the optic nerve disc, often accompanied by hemorrhages. In the outcome, there may be caseous tuberculosis necrosis with the transition to atrophy. Tuberculosis can be accompanied by retinal edema in the macular area in the form of a star, while central vision suffers;
8. exudative retinitis without a specific pattern - often of allergic origin. It is a small foci in the macular area or several foci near the disk of the optic nerve. In the end, the focus dissipates, there is no scarring;
9. Tuberculosis retinal obesity occurs most often, can have central and peripheral localization. With central localization, endo- and periphlebitis. Two branches of the second-fourth order suffer, the caliber of veins changes, along the way they appear loose grayish exudate, which forms clutches along vessels of insignificant extent. As the process is resolved, the picture of proliferative retinitis.

With peripheral localization in the early stages on the extreme periphery of the retina, a corkscrew curvature appears, new vessels (resembling a fan of palm leaves), fibrin accumulates along the venous wall in the form of a clutch. In the course of the veins, granulomas are seen that cover the lumen and can lead to vascular disruption. Granulomas have the form of white foci along the course of the vessels, with fuzzy boundaries, an elongated shape. Ends with all the hemophthalmitis. Blood in the vitreous can be organized and lead to traction detachment of the retina and secondary uveitis.

Thus, it is possible to distinguish such stages as:

1. expansion and tortuosity of veins;
2. periphlebitis and retipovasculitis;
3. recurrent hemophthalmitis;
4. traction detachment of the retina.

The duration of the active process is up to three years. The disease is described by H. Illz under the title "juvenile recurrent vitreous hemorrhage". In the early XX century, it was believed that the etiology was strictly tubercular. At the present time it is considered that this is a polyethological syndrome associated with specific and nonspecific sensitization of the organism in various diseases, such as endocrine diseases, blood diseases, hemorrhagic diathesis, focal infection, toxoplasmosis, viral diseases, etc.

The prognosis regarding vision is poor. Tuberculous arteritis is much less common. Characterized by the defeat of large arterial stems with the formation of a clutch, ischemic foci along with exudative. In the end - the propensity to proliferative processes.

Syphilitic retinitis

Syphilitic retinitis can be with congenital and acquired syphilis, but more often with congenital syphilis there is not retinitis, but chorioretinitis. With congenital syphilis:

1. changes in the type of "salt with pepper": on the periphery of the fundus there are many white foci (these are inflamed areas of vascular membranes), which are combined with dark foci. Arise in early childhood and last a lifetime. Central vision does not suffer;
2. "Shot shot" - on the periphery of larger concentrations of pigment (round in the form of pathological bodies), which can be combined with whitish foci. Accompanied by atrophy of the optic disc;
3. on the extreme periphery - extensive, sharply confined light foci, often fused as they dissolve. There remain atrophic foci with a scarlet rim around, which persist for years;
4. very severe lesion - the retina, the vascular membrane, the optic nerve are affected. The retina is leaden-gray in color. Throughout the fundus, especially along the course of the vessels, are large (pigmented) foci that sclerize the vascular membrane;
5. congenital syphilitic periphlebitis of the retina - all the characteristic features of periphylebita plus anterior and posterior uveitis.

There are following forms of changes in acquired syphilis:

1. Retinitis without a specific pattern - there may be central and peripheral localization. Central lesion is characterized by damage to the vitreous humor. Against the background of opacity of the vitreous body in the yellow spot - the center of milk color, which extends from the macula to the disk. On its background can be small yellowish foci and small hemorrhages. With desminative retinitis - multiple foci and opacities in the vitreous body in the form of a pulverized suspension;
2. Retinitis with a predominant vitreous affection - in the central parts of the vitreous body - opacities localized above the macula and the disc of the optic nerve. The turbidity of the vitreous is very intense, because the fundus is not visible, the vitreous body is transparent around the periphery. Central vision suffers;
3. gamma retina - isolated in the retina is rare. Usually, it passes from the optic disc and the choroid. Gunma has the form of a yellowish and yellow-red foci, rarely promines into the vitreous. There may be small opacities. Vision rarely decreases. Differential diagnosis is performed with a tumor;
4. syphilitic periarteritis of the retina occurs in the form of peri- and panarritis. Arteries look like white bands, often the changes are not the retina, but the area of the optic nerve disk. Sometimes the hemorrhagic component prevails. The outcome is proliferative retinitis.

Rheumatic retinitis

On the fundus there are:

1. short gray-white clutches along the vessels of the type of circular cuff, having jagged edges;
2. peri-acicular banded retinal edema;
3. Petechiae or hemorrhages are noted;
4. tendency to intravascular thrombus formation - a picture of the obstruction of the arteries and veins of the retina.

In severe forms, the vessels of the optic nerve disk also suffer, then the "caps" of the exudate on the disk, the vat-like foci, the figure of the "star" in the macula.

In the absence of treatment, a secondary perivascular fibrosis is formed. At treatment the forecast favorable.

Toxoplasmosis retinitis

When toxoplasmosis - the exudative nature of vasculitis, the arteries and veins are affected, the lesion begins from the periphery, and then spreads to the center. There is an abundant accumulation of exudate, which envelops the vessels and spreads to the retina. Often occurs exudative detachment of the retina. With acquired toxoplasmosis - the central exudative retinitis.

Brucellosis retinitis

Brucellosis - changes most often in the type of primary angiitis. The retina is affected (more often with latent flow of brucellosis). A total retinovasculitis is characteristic from the central to the peripheral parts, perhaps in the exudative and hemorrhagic type. Couplings can spread in the form of small strata and over a considerable extent. Small couplings resemble drops of stearin located along the vessels. There may be exudative detachment of the retina with the formation of a shvart.

[3], [4], [5], [6]

Pseudoalbuminuric retinitis

Pseudoalbuminuric retinitis is a vascular disorder and an increase in vascular permeability in general infectious diseases (measles, meningitis, erysipelas, syphilis, caries, helminthiases).

Fetal drugs, alcohol, anemia, excessive physical exertion are also important.

Objectively, when examining the fundus, the optic nerve disk is hyperemic, with streaked borders, bright foci and hemorrhages in the retina; in the macula - changes in the form of a "star". Differences from renal retinopathy - there is no retinal edema, the process is reversible.

Other types of retinitis

Symptom of white spots

Inflammatory multifocal changes in the retina and choroid appear in many infectious diseases.

Multiple quick-passing white spots

The etiologic factor is not established. In some patients, spots appear after a viral infection, the introduction of hepatitis B vaccine.

The syndrome is characterized by a typical clinical picture, functional changes and the form of the flow. The main difference from the syndromes of multifocal choroiditis and histoplasmosis is that the inflammatory foci appear quickly, disappear within a few weeks and do not pass into the atrophic stage.

Usually women of young and middle age are ill. The disease begins on one eye with a sudden loss of vision, the appearance of a photopsy, changes in the temporal boundaries of the field of vision, and a blind spot. ERG and EOG pathological.

Ophthalmoscopic picture: a lot of delicate, unobtrusive whitish-yellowish spots of different size are found in the posterior pole in the deep layers of the retina, mostly nasally from the optic nerve, the optic nerve disk is swollen, the vessels are surrounded by couplings. In the early phase of the angiogram, weak hyperfluorescence of white spots, dye penetration, and later staining of retinal pigment epithelium are noted. In the vitreous body, inflammatory cells are found. With the development of the process in the macular area, there is a weak granular pigmentation.

Treatment of the disease, as a rule, do not.

Acute multifocal placoid epitheliopathy

Characteristic signs of the disease - sudden loss of vision, the presence of multiple scattered cattle in the field of vision and large foci of cream-colored lesions at the level of pigment epithelium in the posterior pole of the eye. Acute multifocal placoid pigment epitheliopathy occurs after such prodromal conditions as a rise in body temperature, malaise, muscle pains observed with influenza, respiratory viral or adenoviral infection. The combination of multifocal placoid pigment epitheliopathy with the pathology of the central nervous system (meningoencephalitis, cerebral vasculitis and infarcts), thyroiditis, renal vasculitis, erythema nodosum is noted.

The clinical picture of the disease is represented by multiple whitish-yellow spots at the level of retinal pigment epithelium. They disappear when the general inflammatory process is stopped.

[7], [8], [9]

Acute focal retinal necrosis

The disease occurs at any age. Characteristic symptoms are pain and decreased vision. In the clinical picture there are white necrotic foci in the retina and vasculitis, to which optical neuritis is then attached. Acute damage to the retina occurs, as a rule, with a systemic viral infection, for example, with encephalitis, herpes zoster, chicken pox. Necrosis starts at the periphery of the retina, progresses rapidly and spreads to the posterior pole of the eye, accompanied by occlusion and necrosis of the retinal vessels. In most cases, a retinal detachment with numerous gaps arises. Immunopathological mechanisms play an important role in the development of the disease.

Treatment of this retinitis systemically and locally - antiviral, anti-inflammatory, antithrombotic, surgical treatment.

[10], [11], [12], [13], [14], [15], [16], [17], [18],