neuroretinitis desease

1. NEURORETINITIS
SUHERY
INFECTION IMMUNOLOGY SUBDIVISION
OPHTHALMOLOGY DEPARTMENT
MEDICAL FACULTY ANDALAS UNIVERSITY
DR. M. DJAMIL HOSPITAL PADANG
2022

2. 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)

3. 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

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

5. 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
idiopathic cases

6. Funduskopi of Neuroretinitis

7. 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

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

9. 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

10. 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

11. 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

12. THANK YOU