Neuroretinitis is characterized by optic disc edema and a macular star pattern. It is often idiopathic but can be associated with viral infections. Common symptoms include sudden vision loss without pain. Evaluation involves serological testing and imaging to investigate for infectious etiologies. While it typically resolves spontaneously on its own, specific antibiotic treatment may aid recovery if an infection is identified. The prognosis is generally good with resolution of disc edema within 6-8 weeks and macular star within a year, resulting in restored vision.

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