Chorioretinitis - Causes, Symptoms and Treatment .MF .
Chorioretinitis - acute or chronic inflammation of the posterior section of the choroid involving the retina.There are congenital and acquired.
To lead the development of disease following states:
- infection (toxoplasmosis, tuberculosis, syphilis, herpes virus), including local (ENT organs, mouth);
- some toxins (for instance, leads to long hemophthalmus chorioretinitis since destroyed elements of blood can be toxic);
- allergic reactions;
- autoimmune conditions;
- immunodeficiency (HIV-infected, debilitated people, after long-term treatment);
Symptoms Depending on the location chorioretinites process can be central (in the macular area), peripapillary (the area around the optic disc), equatorial (near the equator) and peripheral (near the dentate line).As the prevalence divided into focal, multifocal disseminated (multiple foci), diffuse.Adrift are sharp (up to 3 months) and chronic (frequently recurs).
typical complaints appear, depending on the location.Peripheral chorioretinitis may be asymptomatic, they are detected by routine inspection.If it affects the macular area of the patient sees blurred and blurred vision, dark spots, flashes (photopsias), sparks before the eyes, the shape and size of objects are distorted (metamorphopsia, micropsia and macropsia), the patient is difficult to navigate at dusk (day-blindness, "night blindness").
Any of these symptoms may indicate a serious disease of the body, so you should immediately consult an ophthalmologist.
following study was performed to confirm the diagnosis:
- visual acuity (with reduced central chorioretinitis, not corrected);
- perimetry, including computer (may occur in cattle, or dark spots, reduced contrast sensitivity of the retina);
- refractometry - does not change with chorioretinitis;
- biomicroscopy - identify changes in the vitreous body;
- research in transmitted light - can cloud the vitreous body;
- ophthalmoscopy with broad pupil with Goldman lens.Depending on the form and stage of the fundus different pattern.Classic change: grayish-yellowish lesions with indistinct borders, extending into the vitreous humor (in the stage of infiltration), along the vascular fluid, may hemorrhage.Further boundaries are clear, and there is pigmentation in the focus area.As time develops atrophy and retinal vascular membrane in the affected area.Ophthalmoscopic picture other horioiditov will be described hereinafter;
- fluorescence angiography detects the change of the fundus vessels (microaneurysms, shunts and others.);
- electroretinography to determine the functional condition of the retina;
- optical coherence tomography of the retina - determine the morphology of the inflammatory focus;
- ultrasound detects changes and cloud environments eyes
Uzi at chorioretinitis
To install causes chorioretinitis use the following methods: general clinical blood and urine tests, blood on RW discs, hepatitis, HIV, toxoplasmosis, herpes, cytomegalovirus,chest Photofluorography, the Mantoux test if indicated.If necessary, carry out counseling therapist, pediatrician, infectious disease, immunology, allergology, venereology, TB doctor, otolaryngologist, dentist.
Clinical picture of some chorioretinites
toxoplasmosis chorioretinitis almost always congenital.Infection occurs in utero.Lesions detected in the central nervous system and other organs.Periods of remission alternating with relapses.Chronic lesions have distinct borders with rough pigmentation.With the active process of infiltration appears at the edges of old lesions.Fresh lesions prominiruyut vitreous, possible retinal detachment, retinal hemorrhage, followed by the formation of neovascular membrane.
Tuberculous chorioretinitis secondary, that is, there is the presence of the primary lesion, usually in the lungs.In the fundus appear disseminated tubercles, chorioretinal scars remain after treatment.Tuberculous-allergic inflammation of the choroid have characteristic distinguishing features.
Syphilitic chorioretinitis characterized the painting "salt and pepper" in the fundus.At the same time centers of pigmentation alternating with areas of fibrosis and atrophy.
Chorioretinitis occurs on the background of immunodeficiency and is often the cause of CMV with HIV.It is characterized by extensive common lesion is necrotic and hemorrhagic in nature, it is difficult to treat and lead to blindness.
Treatment Treatment should be timely and individually appointed.Topical therapy is ineffective, except parabulbar and retrobulbar injections.Use the following group of drugs:
- etiotropic - aimed at eliminating the causes of chorioretinitis.When bacteria are used broad-spectrum antibiotics to identify the causative agent.Then, depending on the sensitivity prescribe certain antibiotics.When viral chorioretinites used interferons, interferon inducers and anti-viral drugs.When syphilitic chorioretinitis prescribe antibiotics penicillin group long course up to 1 month (if the intolerant, then the doxycycline, macrolides and cephalosporins).If the process is caused by Toxoplasma, then apply sulfadimezin and pyrimethamine with folic acid and vitamin B12.Tuberculous chorioretinitis treated together with the TB specialist.An indicative list of drugs in chronic course of isoniazid and rifampin, streptomycin, kanamycin, and hormonal agents.Herpes infection is treated with acyclovir 0.2 grams of 5 times a day, cytomegalovirus - ganciclovir intravenously
- anti-inflammatory drugs, including hormonal.For example, indomethacin, diclofenac or hydrocortisone and dexamethasone inside, intramuscularly, intravenously, or topically (long-acting drug for parabulbarnom 1 every 2 weeks - Diprospan)
- detoxification therapy - for example, gemodez or glucose solution 5% in 400 ml intravenous drip
- immunotherapy - depending on the severity of the process used immunosuppressive agents (with the active chorioretinitis fluorouracil, mercaptopurine) or adjuvants (eg, HIV infection levamisole)
- hyposensitization therapy is carried out using antihistamines (Suprastin, Claritin, Aerius, etc.)
- to increase the body's resistance shows vitamins (C, B group, preferably multivitamin preparations)
- locally used enzymes to accelerate the resorption of inflammatory center, for example retrobulbarno fibrinolizin, gemazu, histochrome or lidazu
- in the absence of response to treatment, heavyor a prolonged duration of chorioretinitis, shows use of extracorporeal detoxification methods such as hemosorbtion, plasmapheresis.
Physiotherapy is important for a speedy recovery.The good effect is by electrophoresis or Lydasum fibrinolizinom.
To slow the spread of inflammation using laser coagulation of the retina, thereby delimiting chorioretinal lesions from normal tissues.In the formation of chorioretinal membranes or detachment required vitrectomy.
Chorioretinitis - a serious disease that leads at untimely or inadequate treatment for complications such as retinal detachment, neovascular membrane, recurrent retinal hemorrhage, retinal vein thrombosis, and others in which you can go blind.
Ophthalmologist Letyuk TZ