Retinitis( inflammation of the retina): symptoms and treatment
Mar 25, 2018
Retinitis is called retinal inflammation.Isolated retinitis is rare, and often occurs in conjunction with the defeat of the choroid of the eye - the choroid.Therefore, more often this pathology ophthalmologists are considered in the chorioretinitis.Table of contents:
Reasons for retinitis
There are two types of receptors in the retina: rods and cones.The former are responsible for peripheral and twilight vision, and the latter for visual acuity and color perception.That is why when the retina is damaged, visual impairment occurs.
As a rule, retinitis develops with hematogenous migration of infection from the inflamed internal organs through the central artery.The retina closely contacts the choroid of the eye, which causes the inflammatory process to spread rapidly from one shell to the other.In this case, they talk about the development of chorioretinitis.
Retinitis develops due to the following reasons:
- Infectious diseases of the body( tuberculosis, toxoplasmosis, syphilis, cytomegalovirus, herpes infection);
- Collagenoses( rheumatism);
- Allergic processes in the body;Diseases of the blood( leukemia);
- Endocrine diseases( diabetes mellitus);
- Hereditary factors( degenerative changes in the retina);
- Eye trauma;
- Ionizing radiation.
Symptoms of the disease
The retina does not have a sensitive innervation, which is why its lesion occurs without pain.First of all, the patient is worried about vision deterioration.With the localization of the inflammatory focus in the area of the macula, central vision is disturbed, as well as color perception.When the periphery of the retina is damaged, the patient has a drop in the visual fields, in addition, twilight vision is disturbed.
Often, in the retinitis of patients, metamorphopsia is disturbed, that is, the diffuse nature of the objects and the photopsy - the appearance of flashes before the eyes.
In the absence of treatment inflammatory foci can be transformed into extensive scars, which leads to poor eyesight.
Occurs when drifting pyogenic microorganisms from the inflamed internal organs into the retina.Metastatic retinitis develops with pneumonia, endocarditis, meningitis, sepsis( in particular postpartum).With septic retinitis, the retinal vessels are damaged.
The disease can provoke the development of metastatic ophthalmia.With this disease, multiple whitish foci are formed on the fundus, located near the vessels.Inflammatory foci in the area of the macula often acquire a stellate form.Gradually the inflammatory process progresses, the edema of the optic nerve disc develops, while the vitreous body becomes dull, its purulent melting leads to panophthalmitis.
Caused by influenza viruses, adenovirus, herpes.With influenza, changes in the retina are observed quite often.First of all, the transparency of the retina is broken to varying degrees.Thus, in some patients only mild diffuse opacification of the membrane can be observed, while in others, the appearance of white spots of different sizes can be observed.The clouding of the retina is caused by the swelling of the interstitial substance.
The turbid areas resemble cotton wool, located mainly in the macula area, as well as around the optic nerve disc.Vessels located in this area are not visualized.
Over time, white spots decrease, become more transparent, and then disappear.Sight is restored.However, the course of the disease often acquires a recurrent nature.It is necessary to fear exudative detachment of the retina, as well as pigmentary degeneration of the retina.
This is a slowly developing retinal infection that occurs in people with immunodeficient conditions, particularly in HIV.On the fundus there is formed a slowly growing retinal foci, gradually capturing all layers of the retina.As the inflammatory focus spreads, hematogenous retinal detachment can occur.Often, the focus is located in the posterior pole, although the inflammatory process can be localized absolutely in any part of the retina.
Syphilis is a venereal disease caused by pale treponema.Infection of the eye tissues with syphilis occurs in the second-third stage of the disease.There is also chorioretinitis in children with congenital syphilis.
For congenital syphilitic chorioretinitis, a symptom of "salt with pepper" is characteristic, when on the periphery of the fundus there are a number of foci of white color alternating with dark foci.This sign lasts a lifetime.
With acquired syphilis, there are signs of diffuse chorioretinitis.There is swelling of the retina and optic nerve disc, a thin diffuse suspension in combination with rough floating opacities is present in the vitreous humor.In addition, hemorrhages in the retina may occur.After the acute phase of syphilis subsides, multiple atrophic foci of the choroid are formed, partially pigmented.
The development of toxoplasmosis retinitis is often associated with intrauterine infection.But it is worth noting that the symptoms of eye lesions do not always manifest themselves at an early age.
With an inactive form of the disease, obsolete large atrophic or scar scarred chorioretinal foci with hypertrophy of the retinal pigment layer are found.Foci are often single, rather than multiple, located in the posterior pole of the eye.
In the acute phase of toxoplasmosis on the fundus, as well as along the edge of the old changes, new inflammatory foci arise.It is necessary to fear exudative detachment of the retina, as well as retinal hemorrhages.
When mycobacteria enter the eye, the vascular membrane is primarily affected.With peripheral localization of the inflammatory process on the periphery of the retina, there is a corkscrew crimp of the vessels, and along the venous wall, fibrin accumulates in the form of a clutch.In the course of veins, granulomas are visualized, which are white foci of elongated form.There is a hemorrhage with the development of hemophthalmitis, which can provoke traction detachment of the retina.
With this ailment on the fundus there are whitish couplings with jagged edges, located along the vessels, as well as perivascular banded retinal edema.In addition, hemorrhages may occur.In the absence of treatment, the vessels of the optic nerve disc also suffer, which leads to a deterioration in vision.Later on, exudative foci of the stellate form are formed in the region of the disc.In the absence of timely therapy, a secondary perivascular fibrosis develops.
Pigmented retinitis is a dystrophic and not inflammatory-infectious disease, but it traditionally belongs to the retinitis group.This is a hereditary, degenerative retina disease associated with anomalies of photoreceptors or retinal pigment epithelium.
Progression of the disease leads to a loss of a large volume of photoreceptors and as a consequence of the possible development of blindness. The patient has the following symptoms:
- Night blindness;
- No central or peripheral vision;
- Mesh sight;
- Blurred vision;
- Poor color discrimination.
Ophthalmoscopy determines pigment deposits in the form of so-called bony bodies, a decrease in the number and thinning of the blood vessels, a waxy paleness of the optic nerve disk.
This is a fairly rare congenital disorder causing partial or total blindness.The causes of the occurrence are not known.It is characterized by an abnormal development of the vessels behind the retina.As a result, massive exudation and hemorrhages in the outer layers of the retina develop.Thus, exudate and blood are concentrated between the retina and the choroid.These factors can lead to detachment of the retina.
The disease is found in childhood or adolescence, more often among men.In most cases, one eye is affected.The patient is concerned about blurred vision, impaired vision, and photopsy.An interesting sign of the ailment is the fact that in photos taken with a flash, the patient's eyes are yellow, not red.This is due to the reflection of light from the deposition of cholesterol in the retina.
When ophthalmoscopy in the retina, vata-like foci without clear boundaries are visualized, as well as interrupted vessels.The foci are often located near the yellow spot or the disc of the optic nerve.As the disease develops, the foci increase, merge with each other.A characteristic feature is the presence of miliary aneurysms along the veins.
Treatment of retinitis
Treatment of retinitis conservative. The treatment regimen is as follows:
- Use of antibacterial agents, taking into account the sensitivity of the microorganism;
- Use of antiviral drugs( ganciclovir, acyclovir);
- Introduction of glucocorticosteroids( dexamethasone, methylprednisolone) is periocular and inward;
- Retrobulbar introduction of enzymes( hematase, lidase, fibrinolysin) for resorption of the inflammatory focus;
- Use of medications that strengthen the vessel wall( ascorutin, dicinone, ascorbic acid).
Grigorova Valeria, medical reviewer