chorioretinitis

Chorioretinitis is an inflammatory condition involving the choroid and retina. It can result from infectious agents or noninfectious inflammatory diseases and may affect one or both eyes. Patients commonly report decreased vision, floaters, or blind spots; eye pain is not typical unless the anterior segment is involved.

Etiology: Infectious causes include toxoplasma gondii, cytomegalovirus, other herpesviruses, syphilis, and tuberculosis. Noninfectious causes include sarcoidosis, Behçet disease, and other autoimmune uveitides. Immunocompromised individuals are at higher risk for certain infections such as CMV retinitis.

Pathophysiology: Infection leads to focal retinal necrosis with choroidal involvement and inflammatory cells in the vitreous. In noninfectious cases, immune-mediated inflammation damages retinal pigment epithelium and choroid.

Diagnosis: Ophthalmic examination reveals retinochoroidal lesions with vitreous haze. Fluorescein and indocyanine green angiography, optical coherence tomography, and serologic testing (eg, toxoplasma antibodies, HIV, syphilis) support diagnosis. PCR of intraocular fluids may be used when infection is uncertain.

Treatment: Therapy is etiology dependent. Toxoplasmic chorioretinitis is treated with antiparasitic regimens (eg, pyrimethamine-sulfadiazine and leucovorin, or alternatives like TMP-SMX) with corticosteroids as indicated. CMV retinitis requires antiviral therapy. Noninfectious chorioretinitis is managed with systemic corticosteroids and immunosuppressants; localized steroids may be used as needed, along with treatment of the underlying systemic disease.

Prognosis and prevention: Visual outcome varies with extent and promptness of treatment. Complications include retinal detachment, macular scarring, and secondary glaucoma. Prevention focuses on treating underlying diseases and preventing opportunistic infections in high-risk patients.