Tuberculous chorioretinitis.

In disseminated tuberculous chorioretinitis, foci of varying age and shape are detected in the choroid and retina using ophthalmoscopy. Against the background of old foci with clear boundaries and pronounced pigmentation along the edge, more recent foci of a yellowish-gray color with unclear boundaries appear, surrounded by perifocal edema, somewhat protruding, and sometimes bordered by hemorrhage. Edema of the retina can also be observed for some time along the edge of old foci. The foci have different sizes and shapes, are located in groups, occupying large areas of the fundus, and do not merge with each other. The process can spread to the anterior part of the choroid proper, accompanied by a rash of precipitates, the appearance of goniosynechiae, exogenous pigmentation of the angle of the anterior chamber of the eye, and newly formed vessels in the iris at its root.

Diffuse tuberculous chorioretinitis most often develops in children and adolescents against the background of chronic primary tuberculosis. In this pathology, massive exudation into the preretinal parts of the vitreous body is also observed. The ciliary body and iris may be involved in the process.

Central tuberculous chorioretinitis may develop with tuberculosis of all localizations. In the area of the macula lutea there is a relatively large protruding focus of exudation with a yellowish tint or gray-slate color with perifocal edema (exudative form). The focus may be surrounded by hemorrhages in the form of spots or a rim (exudative-hemorrhagic form). Perifocal edema and the resulting two-contour radial reflexes are better seen in red-free light.

Central tuberculous chorioretinitis is differentiated from transudative macular degeneration, central granulomatous process developing in syphilis, brucellosis, malaria, etc.

Other forms of the disease are also possible, such as metastatic tuberculous granuloma localized near the optic nerve head. In this case, retinal edema is observed around the optic nerve, edema of the optic nerve head and blurring of its borders. Due to retinal edema, the choroidal lesion may not be detected in the active phase. In some cases, an erroneous diagnosis of optic papillitis or neuritis is established. A sector-shaped scotoma merging with the blind spot is determined in the visual field. As the infiltrate and retinal edema resolve, a choroidal lesion is detected, localized near the optic nerve head under the retina. The lesion scars. Central vision remains good. This is Jensen's juxtapapillary choroiditis. The disease usually develops in late childhood and adolescence, more often in people 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 strengthening treatment after consultation with a phthisiatrician.

Sanitation of infection foci (teeth, paranasal sinuses, tonsils, etc.) is necessary. Mydriatics and corticosteroids are prescribed locally. A solution of dexazone is administered parabulbarly, streptomycin-calcium chloride complex of 25,000-50,000 U is administered under the conjunctiva, and a 5% solution of salyuzide of 0.3-0.5 ml is administered. Electrophoresis with anti-tuberculosis drugs is indicated.

Fluorescein angiography makes it possible to assess the degree of activity of tuberculous chorioretinitis, monitor the effectiveness of the treatment, and determine the volume and timing of laser coagulation.