A presentation on complete clinical profile of Neuroretinitis.

1. NEURORETINITIS
Dr Saurabh Kushwaha
Resident Ophthalmology

2. SCOPE
 Background
 Etiology
 Clinical features
 Differential diagnosis
 Investigations
 Clinical Progression
 Treatment

3. BACKGROUND
 Optic disc edema with
macular star (ODEMS)
 1st described by Leber (1916)
as stellate maculopathy
 Gass (1977) renamed it as
neuroretinitis
 Leber’s idiopathic stellate
neuroretinitis

4. ETIOLOGY
 Idiopathic - 50%
 Viral infections (MC association)
 Common specific infections:
 Cat scratch disease (Bartonella)
 Syphilis
 Toxoplasmosis
 Lyme disease
 Leptospirosis
 Toxocariasis
 Helminths (Diffuse unilateral subacute neuroretinitis,
DUSN)

5. CLINICAL FEATURES
 Most commonly affects 3rd and 4th decade
 No sex predilection
 Either eye or both eye can be affected
 Sudden decrease in vision without pain
 Loss of colour vision
 Loss of contrast sensitivity
 Metamorphopsia

6. EVALUATION
 Complete history for
 Viral infections
 Associations with animals
 Sexually transmitted diseases
 Systemic examination with special emphasis
on neurological examination

7. OCULAR EXAMINATION
 RAPD present in unilateral cases
 Occasionally, reaction in anterior chamber
 Disc oedema which precede appearance of
macular star
 Splinter haemorrhages in severe cases
 Occasionally, cells in posterior vitreous
 Small, discrete chorioretinal lesions in
idiotpthic cases

9. Fluorescein Angiography shows diffuse edema
at disc and diffuse leakage of dye from vessels
on the disc surface
 Visual field defects - centrocaecal scotoma
(MC), central scotoma and arcuate defects
 OCT demonstrates sub- and intraretinal fluid
to a variable extent

10. INVESTIGATIONS
 Serological tests for Bartonella, Lyme
disease, syphilis, Toxoplasmosis and
toxocariasis
 Mantoux test
 Chest X ray
 CSF analysis
 Neuro-imaging with MRI

11. DIFFERENTIAL DIAGNOSIS
 Papilledema (raised ICT)
 ONH tumour
 Infilterative neuropathy
 Vascular diseases
 Anterior ischemic optic neuropathy (AION)
 Systemic hypertension
 Diabetes
 PAN
 Fluorescein Angiography in above conditions
will show leakage of dye from macula as well,
unlike Neuroretinitis

12. TREATMENT
 Resolves spontaneously without treatment
 Treatment - speedy recovery and shorter course
of disease
 Specific antibiotic therapy
 Bartonella - Doxycycline
 Syphilis - iv Penicillin
 Toxoplasmosis - pyrimethamine, sulfadiazine,
and corticosteroids
 Leptospirosis - iv Penicillin, Doxycycline
 Recurrent cases - Steroids/immunosuppressant

13. CLINICAL PROGRESSION
 Self limiting and recovers spontaneously
 Visual progression is very good
 Disc oedema resolves in 6-8 weeks
 Macular star may resolve in 1 year
 Rarely, visual recovery remain poor
 Rarely, optic atrophy may be seen
 Recurrence is rare

14. SUMMARY
 Resolves spontaneously without treatment
 Idiopathic, unilateral, self limiting, with good
visual prognosis
 Rarely can be recurrent, bilateral, with optic
atrophy and poor visual prognosis

15. THANK YOU