retinitis

Retinitis refers to inflammation of the retina, the light-sensitive layer at the back of the eye. It can result from infectious processes or noninfectious inflammatory conditions, and may involve the underlying choroid (retinochoroiditis). Symptoms vary and can include vision changes such as blurred vision, blind spots, floaters, or less commonly eye pain; some cases are asymptomatic and discovered on examination.

Clinical features commonly seen on eye examination include retinal edema, hemorrhages, cotton-wool spots, necrotic areas, and vasculitis. In immunocompromised individuals, cytomegalovirus (CMV) retinitis may produce a characteristic appearance with hemorrhagic necrosis often described as a “pizza pie” retina. Other infectious causes include herpesviruses causing acute retinal necrosis and Toxoplasma gondii retinitis. Noninfectious causes encompass autoimmune or inflammatory retinopathies that may accompany systemic inflammatory diseases.

Diagnosis relies on a comprehensive eye examination and imaging, such as optical coherence tomography and fluorescein angiography. Laboratory testing and PCR analysis of ocular fluids can identify viral DNA or other pathogens. Systemic evaluation is important to identify immunosuppression or an underlying infectious or inflammatory condition.

Treatment is etiology-specific. Viral retinitis is treated with antiviral therapy (e.g., ganciclovir, valganciclovir, foscarnet), administered systemically and/or intravitreally. Toxoplasma retinitis is treated with antiparasitic regimens (often pyrimethamine-sulfadiazine with leucovorin or clindamycin). Corticosteroids may be used to control inflammation after infection is controlled. In HIV infection, antiretroviral therapy is essential, and management targets restoration of immune function.

Prognosis varies by cause and extent of retinal involvement. Untreated retinitis can lead to significant vision loss and complications such as retinal detachment. Early diagnosis and targeted therapy improve outcomes, with ongoing monitoring by an ophthalmologist.