Summary about Disease
Chorioretinitis refers to inflammation affecting both the choroid (the vascular layer of the eye) and the retina (the light-sensitive layer). This inflammation can lead to scarring and vision loss. Various infectious and non-infectious causes can trigger chorioretinitis. The severity and prognosis depend on the underlying cause, location, and extent of the inflammation.
Symptoms
Symptoms of chorioretinitis can vary depending on the location and severity of the inflammation, but may include:
Blurred vision
Decreased vision
Floaters (spots or specks in the field of vision)
Pain in the eye (less common)
Redness of the eye (less common)
Light sensitivity (photophobia)
Visual field defects (blind spots)
Causes
Chorioretinitis can be caused by a variety of factors, including:
Infections:
Toxoplasmosis (most common infectious cause)
Syphilis
Tuberculosis
Herpes simplex virus (HSV)
Varicella-zoster virus (VZV)
Cytomegalovirus (CMV) (more common in immunocompromised individuals)
Fungal infections (e.g., histoplasmosis, candidiasis)
Autoimmune diseases:
Sarcoidosis
Behçet's disease
Vogt-Koyanagi-Harada (VKH) syndrome
Other:
Trauma
Idiopathic (unknown cause)
Congenital conditions
Medicine Used
The medications used to treat chorioretinitis depend entirely on the underlying cause.
Infectious causes:
Toxoplasmosis: Pyrimethamine, sulfadiazine, and folinic acid (leucovorin) are a common combination. Alternatives include clindamycin, azithromycin, and trimethoprim-sulfamethoxazole.
Syphilis: Penicillin is the primary treatment.
Tuberculosis: Antitubercular medications (e.g., isoniazid, rifampin, ethambutol, pyrazinamide).
Herpes viruses: Antiviral medications (e.g., acyclovir, valacyclovir, ganciclovir, foscarnet).
Fungal infections: Antifungal medications (e.g., amphotericin B, fluconazole, voriconazole).
Autoimmune causes:
Corticosteroids (e.g., prednisone) to reduce inflammation.
Immunosuppressants (e.g., methotrexate, azathioprine, cyclosporine) for longer-term control.
Other:
Topical steroids (eye drops) may be used to reduce inflammation in some cases.
In some instances, anti-VEGF injections may be used.
Is Communicable
Whether chorioretinitis is communicable depends on the underlying cause.
Infectious causes: Some infectious causes, such as toxoplasmosis (acquired from undercooked meat or cat feces) or congenital syphilis, are not directly communicable from person to person. However, syphilis *is* communicable through sexual contact or from mother to fetus. Some other infections like Tuberculosis, Herpes Viruses may be communicable.
Non-infectious causes: Autoimmune diseases and idiopathic cases are not communicable.
Precautions
Precautions depend on the cause of the chorioretinitis.
Infectious causes:
Toxoplasmosis: Proper food handling (cooking meat thoroughly, washing hands after handling raw meat), avoiding contact with cat feces (especially for pregnant women).
Syphilis: Safe sex practices, screening and treatment during pregnancy.
Tuberculosis: Isolation and respiratory precautions for active TB, screening of contacts.
Herpes viruses: Avoid contact with lesions, antiviral medication to prevent outbreaks.
General:
Regular eye exams, especially for individuals with risk factors for chorioretinitis (e.g., immunocompromised individuals, those with autoimmune diseases).
Prompt medical attention for any new or worsening eye symptoms.
How long does an outbreak last?
The duration of a chorioretinitis outbreak varies significantly depending on the underlying cause and the effectiveness of treatment.
Infectious causes: Treatment duration can range from weeks to months, depending on the specific infection and the individual's response to medication.
Autoimmune causes: Autoimmune-related chorioretinitis can be chronic and relapsing, requiring long-term management with immunosuppressants. Flares can last weeks to months.
Without treatment, the inflammation can persist and cause permanent vision loss.
How is it diagnosed?
Diagnosis of chorioretinitis typically involves a comprehensive eye examination by an ophthalmologist. This may include:
Visual acuity testing: To assess the sharpness of vision.
Slit-lamp examination: To examine the front of the eye (including the cornea, iris, and lens).
Dilated fundus examination: To examine the retina, choroid, and optic nerve after dilating the pupils.
Optical coherence tomography (OCT): To obtain detailed images of the retina and choroid.
Fluorescein angiography: To visualize the blood vessels in the retina and choroid.
Indocyanine green angiography (ICGA): To visualize the choroidal blood vessels.
Visual field testing: To assess the extent of any visual field defects. Additional tests may be needed to determine the underlying cause of the chorioretinitis, such as:
Blood tests: To look for infections (e.g., toxoplasmosis, syphilis, tuberculosis), autoimmune markers, or other systemic conditions.
Polymerase chain reaction (PCR) testing: To detect specific pathogens in ocular fluids.
Spinal tap (lumbar puncture): In rare cases, to evaluate for central nervous system involvement.
Timeline of Symptoms
The timeline of chorioretinitis symptoms can vary.
Acute onset: Some conditions, such as viral infections, can cause a rapid onset of symptoms over a few days.
Gradual onset: Other conditions, such as toxoplasmosis or autoimmune diseases, may develop more gradually over weeks or months.
Symptoms can fluctuate in severity, with periods of worsening (flares) and improvement (remission), particularly in autoimmune-related chorioretinitis.
Important Considerations
Prompt diagnosis and treatment are crucial to minimize vision loss.
The underlying cause of chorioretinitis must be identified to guide appropriate treatment.
Treatment may involve a combination of medications and lifestyle modifications.
Long-term follow-up is often necessary to monitor for recurrence or complications.
Individuals with chorioretinitis should be educated about their condition, treatment options, and potential risks and benefits.
Pregnant women should be screened for infections that can cause congenital chorioretinitis (e.g., toxoplasmosis, syphilis).
Immunocompromised individuals are at higher risk for certain types of chorioretinitis (e.g., CMV retinitis).