Tuberculous chorioretinitis

With disseminated tuberculosis chorioretinitis, ophthalmoscopy reveals different prescription and forms of foci in the choroid and retina. Against the background of old foci with clear boundaries and pronounced pigmentation along the edge, more foci of yellowish-gray color with fuzzy boundaries appear, surrounded by perifocal edema, somewhat piercing, and sometimes bordered by hemorrhage. Retinal edema can be observed for some time along the edge of the old foci. Foci have different sizes and shapes, are arranged in groups, occupying vast areas of the fundus, do not merge with each other. The process can spread to the front of the vascular wall proper, accompanied by precipitation of precipitates, the appearance of goniosynexia, exogenous pigmentation of the angle of the anterior chamber of the eye, newly formed vessels in the iris near its root.

Diffuse tuberculous chorioretinitis often develops in children and adolescents against a background of chronically current primary tuberculosis. In this pathology, massive exudation to the preretinal sections of the vitreous is also observed. The ciliary body and iris can be involved in the process.

Central tuberculous chorioretinitis can develop with tuberculosis of all localizations. In the area of the yellow spot there is a relatively large predominant exudation focus with yellowish tinge or gray-slate color with perifocal edema (exudative form). The focus can be surrounded by hemorrhages in the form of spots or corolla (exudative hemorrhagic form). Perifocal edema and the two-contour ray reflexes conditioned by it are seen better in a red light.

Central tuberculous chorioretinitis is differentiated from transudative dystrophy of the macula, the central granulomatous process that develops with syphilis, brucellosis, malaria, etc.

Other forms of the disease are possible, for example metastatic tuberculosis granuloma, localized at the optic nerve disc. In this case, retinal edema is observed in the circumference of the optic nerve, edema of the optic nerve disk and the smearing of its boundaries. Due to retinal edema, a choroidal focus in the active phase may not be detected. In some cases, an erroneous diagnosis of optical papillitis or neuritis is established. A sectoral scotoma is identified in the field of view, merging with a blind spot. As the infiltrate dissolves and the retinal edema, a choroidal focus localized near the optic disc under the retina is identified. The center is scarred. Central vision remains good. This is Jensen's juxtapapillary choroiditis. The disease usually develops in older children and adolescents, more often in individuals prone to allergies.

Treatment of tuberculous chorioretinitis

Treatment of tuberculous chorioretinitis is carried out with anti-tuberculosis drugs in combination with desensitizing therapy and general restorative treatment after consultation of a phthisiatrician.

It is necessary to sanitize foci of infection (teeth, paranasal sinuses, tonsils, etc.). Locally appoint mydriatica, corticosteroids. Parabulbarno injected solution of dexazone, under the conjunctiva streptomycin-chloralkalcium complex of 25 000-50 000 units, 5% saluside solution of 0.3-0.5 ml. Electrophoresis with anti-tuberculosis drugs is indicated.

Fluorescent angiography provides an opportunity to assess the degree of activity of tuberculous chorioretinitis, monitor the effectiveness of the treatment, determine the extent and timing of laser coagulation.