Congenital chorioretinitis. Serous central chorioretinitis and other forms of the disease. Treatment prognosis and prevention

RCHR (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical protocols Ministry of Health of the Republic of Kazakhstan - 2016

Ophthalmology

general information

Short description


Approved

Joint Commission on Healthcare Quality
Ministry of Health and social development Republic of Kazakhstan
dated June 9, 2016
Protocol No. 4


Chorioretinitis - inflammation of the posterior region choroid with the involvement of the retina in the process.

Date of development of the protocol: 2016

Protocol users: general practitioners, ophthalmologists.

Level of evidence scale:

A A high-quality meta-analysis, systematic review of RCTs, or large RCTs with a very low probability (++) of bias, the results of which can be generalized to an appropriate population.
IN High-quality (++) systematic review of cohort or case-control studies, or High-quality (++) cohort or case-control studies with very low risk of bias, or RCTs with low (+) risk of bias, the results of which can be generalized to an appropriate population .
WITH Cohort or case-control study or controlled trial without randomization with low risk of bias (+).
The results of which can be generalized to the relevant population or RCTs with very low or low risk of bias (++ or +), the results of which cannot be directly generalized to the relevant population.
D Case series or uncontrolled study or expert opinion.
GPP Best pharmaceutical practice.

Classification


Classification: .

Clinical and pathogenetic classification:
I. Infectious and infectious-autoimmune;
II. Allergic for non-infectious allergies;
III. For systemic and syndromic diseases;
IV. Post-traumatic, sympathetic ophthalmia;
V. Retinouveitis in other pathological conditions of the body.

With the flow:
· spicy;
· chronic.

By localization:
peripheral uveitis (parsplanitis)
posterior uveitis:
· focal;
· multifocal;
· disseminated;
· neurochorioretinitis;
endophthalmitis.
panuveitis:
generalized uveitis;
panophthalmitis.

By activity:
· active;
· subactive;
· inactive.

By type of inflammation:
· non-granulomatous;
· granulomatous.

Diagnostics (outpatient clinic)


OUTPATIENT DIAGNOSTICS**

Diagnostic criteria

Complaints:
· decreased visual acuity of varying severity, often rapidly progressing, “fog”, veil, floating dots, flickering, distortion of objects (macro- and micropsia), photopsia, loss of the visual field.

Anamnesis: presence of chronic infections, systemic and autoimmune diseases, previous surgical interventions ah on the organ of vision and orbit.


· in most cases, external examination does not reveal any changes;
palpation level assessment intraocular pressure(indicative method).

Laboratory research:

Required:
· general blood test (to exclude chronic inflammatory and systemic autoimmune processes);
· general urinalysis (to exclude chronic inflammatory and systemic autoimmune processes);
· biochemical blood test (glucose, AST, ALT) (necessary before prescribing corticosteroid drugs, to monitor possible development drug-induced hyperglycemia);
· bacteriological culture from the conjunctival cavity with identification of the pathogen and determination of sensitivity to antibiotics;
· Wasserman reaction;
· blood on HIV method ELISA;
· determination of hepatitis B, C markers using ELISA;
· determination of Ig A, M, G to viruses herpes simplex, cytomegalovirus, toxoplasmosis, chlamydia using ELISA (to determine the etiology and activity of the process.

Additional:
· determination of C-reactive protein in the blood (to exclude systemic and autoimmune diseases);
· blood for rheumatic tests (to exclude systemic and autoimmune diseases).

Basic:
Visometry - decreased visual acuity of varying severity, often rapidly progressing, depending on activity inflammatory reaction, localization of the chorioretinal focus, as well as the development of complications and their severity.
· biomicroscopy of the eye - allows you to identify clouding of the lens, focal or diffuse clouding of the vitreous body, cells, hemorrhages in the vitreous body, and if the anterior segment is involved in the process - corneal precipitates, cells in the anterior chamber, exudate, hypopyon.
· tonometry - used to assess initial intraocular pressure and determine the need to prescribe local antihypertensive drugs in the development of secondary glaucoma.
· ophthalmoscopy - allows you to detect changes in the posterior segment of the eye, inflammatory foci, accompanying stripes, couplings along the vessels, intraretinal hemorrhages, deposition of hard exudate, areas of capillary occlusion, macular edema, neuropathy or atrophy of the optic nerve, arising from chorioretinal inflammation.
· perimetry - possible narrowing of the field of view, relative and/or absolute scotomas (in the area of ​​inflammatory foci), as well as optic nerve or optic tract
· refractometry - to identify possible changes refraction of the eye. Determination of refraction is possible using a kit spectacle lenses(approximate definition of refraction) - a change in refraction during inflammation towards hypermetropia (in the presence of edema in the macular zone).
radiography of organs chest- in order to exclude acute and chronic processes that cause chorioretinitis.
radiography paranasal sinuses nose - is carried out to exclude acute and chronic processes that cause chorioretinitis.

Additional:
· fundus biomicroscopy using an aspheric lens - allows for more detailed visualization of changes in the fundus that develop during chorioretinal inflammation: neuropathy, macular edema, neuroepithelial detachment, retinal detachment, inflammatory foci, accompanying stripes, couplings along the vessels, intraretinal hemorrhages, hard deposits exudate, the presence of zones of capillary occlusion.
· gonioscopy - a method of visual examination of the iridocorneal angle of the anterior chamber of the eye allows to identify goniosynechia, exudate, neovascularization in the angle of the anterior chamber.
· cycloscopy (examination of the periphery of the fundus with a three-mirror Goldmann lens) - allows you to assess the condition of the extreme periphery of the fundus and make a differential diagnosis between chorioretinal inflammation, iridocyclitis and peripheral uveitis.
· ophthalmochromoscopy - allows you to identify details of the fundus that are invisible with conventional ophthalmoscopy.
· electroretinogram - carried out to assess the functional state of the retina, including in opaque optical environments of the eye.
caused by visual potentials(decrease in amplitude and prolongation of lability) make it possible to assess the severity of damage to the optic nerve and optic tract.
· Ultrasound of the eyeball - allows you to assess the condition of the vitreous body (fibrosis), thickening of the membranes, and identify ciliochoroidal retinal detachment. Particularly informative when it is impossible to perform ophthalmoscopy.
· optical coherence retinotomography - allows you to visualize the retina and optic nerve, identify and record changes.
Fluorescein angiography - allows you to identify pathological changes in the choroid, retina (hypo- or hyperfluorescent foci), retinal vessels (extravasal release of fluorescein), and optic nerve head (hyperfluorescence - with inflammation or hypofluorescence - with atrophy).

· radiography of the orbit - to identify pathological changes in the orbit.
· radiography of the skull in one or more projections - is carried out to identify pathological changes that may be accompanied by a clinical picture of chorioretinal inflammation.
· Magnetic resonance examination of the central nervous system and brain - is carried out to identify pathological changes that may be accompanied by the clinical picture of a chorioretinal examination.

Diagnostic algorithm

Diagnostics (hospital)


DIAGNOSTICS AT THE INPATIENT LEVEL**

Diagnostic criteria at the hospital level**:

Complaints:
Reduced visual acuity, varying degrees of severity, often rapidly progressing, “fog”, veil, floating dots, flickering, distortion of objects (macro- and micropsia), photopsia, loss of the visual field.

Anamnesis: the presence of chronic infections, systemic and autoimmune diseases, previous surgical interventions on the organ of vision and orbit.

Visual examination of the eyes: in most cases, external examination does not reveal any changes; palpation assessment of the level of intraocular pressure (indicative method).

Laboratory research:

Required:
. general blood test (to exclude chronic inflammatory and systemic autoimmune processes);
. general urinalysis (to exclude chronic inflammatory and systemic autoimmune processes);
. biochemical blood test (glucose, AST, ALT) (necessary before prescribing corticosteroid drugs, to monitor the possible development of drug-induced hyperglycemia);
. bacteriological culture from the conjunctival cavity with identification of the pathogen and determination of sensitivity to antibiotics;
. Wasserman reaction;
. blood for HIV using ELISA;

. determination of Ig A, M, G to herpes simplex viruses, cytomegalovirus, toxoplasmosis, chlamydia by ELISA.

Additional:
. determination of C-reactive protein in the blood (to exclude systemic and autoimmune diseases);
. blood for rheumatic tests (to exclude systemic and autoimmune diseases).

Instrumental studies:

Basic:
· Visometry - a decrease in visual acuity of varying severity, often rapidly progressing, depending on the severity of the inflammatory reaction, the localization of the chorioretinal focus, as well as the development of complications and the degree of their severity.
· Biomicroscopy of the eye - allows you to identify clouding of the lens, focal or diffuse clouding of the vitreous body, cells, hemorrhages in the vitreous body, and if the anterior segment is involved in the process, corneal precipitates, cells in the anterior chamber, exudate, hypopyon.
· Tonometry - according to A.N. Maklov, with a 10g weight. Used to assess initial intraocular pressure and determine the need to prescribe local antihypertensive drugs when complications such as secondary glaucoma develop.
· Ophthalmoscopy - direct and reverse. Allows you to detect changes in the posterior segment of the eye, inflammatory foci, accompanying stripes, couplings along the vessels, intraretinal hemorrhages, deposition of hard exudate, the presence of zones of capillary occlusion, macular edema, neuropathy or atrophy arising from chorioretinal inflammation.
· Perimetry - a method of studying the field of view on a spherical surface used to determine its boundaries and identify defects in it. A narrowing of the visual field, relative and absolute scotomas are possible with damage to the retina (in the area of ​​inflammatory foci), the optic nerve or optic tract, as well as with the development of complications.
· Refractometry - to identify possible changes in the refraction of the eye.
· Determination of refraction using a set of spectacle lenses - a change in refraction is possible during the inflammatory reaction and the formation of complications.
· Chest X-ray - carried out to exclude acute and chronic processes that may be accompanied or detected when the eyes are affected.
· X-ray of the paranasal sinuses - is carried out to exclude acute and chronic processes that may be accompanied or detected in cases of eye damage.

Additional:
· Biomicroscopy of the fundus - allows you to visualize in more detail changes in the fundus that develop during chorioretinal inflammation: neuropathy, macular edema, detachment and neuroepithelium, retinal detachment, inflammatory foci, accompanying stripes, couplings along the vessels, intraretinal hemorrhages, deposition of hard exudate, the presence zones of capillary occlusion.
· Gonioscopy is a method of visual examination of the iridocorneal angle of the anterior chamber of the eye. Allows you to detect changes in the angle such as goniosynechia, exudate, neovascularization.
· Cycloscopy (examination of the periphery of the fundus with a three-mirror Goldmann lens) - allows you to assess the condition of the extreme periphery of the fundus and carry out differential diagnosis between chorioretinal inflammation, iridocyclitis and peripheral uveitis.
· Ophthalmochromoscopy - allows you to identify details of the fundus that are invisible with conventional ophthalmoscopy.
· It is advisable to record an electroretinogram to assess the functional state of the retina.
· Registration of sensitivity and lability of the visual analyzer - can be assessed functional state optic nerve.
· Electrophysiological study of the visual analyzer - indicates the functional state of the retina, optic nerve, optic tract, but there is no clear correlation between indicators of electrophysiological activity and visual acuity.
· Ultrasound of the eyeball - performed when ophthalmoscopy is impossible or uninformative. Shows the condition of the vitreous body, membranes, ciliochoroidal detachment. With chorioretinal inflammation, fibrosis of the vitreous body and thickening of the membranes are often detected.
· Optical coherence retinotomography - allows you to visualize the retina and optic nerve, identify and record changes;
· Fluorescein angiography of the eye - the method allows you to identify pathological changes in the choroid, retina (depending on the phase of the study and the activity of the process, hypo- or hyperfluorescent foci are detected), retinal vessels (extravasal release of fluorescein), and the optic nerve head (hyperfluorescence of the disc or hypofluorescence during its atrophy)
· Ultrasound of cerebral vessels - the method allows you to determine the patency of the external and internal carotid arteries, as well as the central retinal artery. It is advisable to use in differential diagnosis with ischemic oculopathy.
X-ray of the orbit - carried out to identify pathological changes in the orbit
· X-ray of the entire skull, in one or more projections - is carried out to identify pathological changes that may be accompanied by a clinical picture of chorioretinal inflammation.
· Magnetic resonance examination of the central nervous system and brain - is carried out to identify pathological changes that may be accompanied by the clinical picture of a chorioretinal examination.

Diagnostic algorithm: see outpatient level

List of main diagnostic measures:
. visometry;
. biomicroscopy of the eye;
. tonometry;
. ophthalmoscopy;
. fundus biomicroscopy;
. perimetry;
. Ultrasound of the eyeball;
. electrophysiological studies of the retina and optic nerve;
. general blood analysis;
. general urine analysis;
. biochemical blood test (glucose, AST, ALT);
. Wasserman reaction;
. blood for HIV using ELISA;
. determination of hepatitis B, C markers using ELISA;
. determination of C-reactive protein in the blood.

List of additional diagnostic measures:
. examination of the periphery of the fundus with a three-mirror Goldmann lens;
. optical coherent resonance tomography posterior segment;
. ophthalmochromoscopy;
. fluorescein angiography;
. Ultrasound of the orbit;
. MRI of the brain;
. electroretinography;
. registration of visually evoked potentials (VEP).

Differential diagnosis

Diagnosis Rationale for differential diagnosis Surveys Diagnosis exclusion criteria
Central chorioretinal dystrophy (secondary) In the anamnesis - transferred inflammatory disease eyes. Central scotoma in the field of view. A history of inflammation of the retina or trauma to the organ of vision. On OST - thinning of the retina, on FA - hypofluorescence in the area of ​​the lesion in the early stages, hyperfluorescence with preservation of the size of the lesion and the clarity of its contours - in late phases.
Age-related macular degeneration Decreased visual acuity, central scotoma in the field of view. History, visometry, perimetry, OST, FA Age - over 45-50 years old. The disease occurs in one eye, on average after 5 years - in the second. There is a history of atherosclerosis, hypertension and other vascular pathologies. With ophthalmoscopy: non-exudative phase - hard or soft drusen, geographic atrophy; at exudative form- swelling in the macular area, there may be hemorrhages, subretinal neovascular membrane. On OST: drusen (hard and soft) in a non-exudative form, thickening of the retina (edema), newly formed vessels under the retinal pigment epithelium. On FA - hyperfluorescence in the defect area pigment epithelium, hypofluorescence in the area of ​​hemorrhages.
Abiotrophy of the retina Decreased vision, presence of defects in the visual field. With ophthalmoscopy - foci various shapes and localization on the retina. Medical history, perimetry, ophthalmoscopy, FA. There is no connection between decreased vision and previous infection. The decrease in vision is often gradual. The presence of heredity. Lesions with clear contours, non-prominent. On FAG there are zones of hypo- and hyperfluorescence with clear contours. Long-term stable preservation of visual functions.
Choroidal neoplasms Decreased visual acuity. On ophthalmoscopy, there is a lesion with unclear contours and prominence. History, ophthalmoscopy, OST, FA, ultrasound, ultrasound With ophthalmoscopy - secondary retinal detachment, drusen on the surface of the formation, “orange pigment fields”, hemorrhages into the neoplasm tissue and the underlying retina, neovascularization. According to ultrasound and OST data, “+ tissue” is determined. Doppler ultrasound reveals the presence of newly formed vessels in the area of ​​the tumor. On FA: Early impregnation of the lesion with fluorescein in the choroidal phase; impregnation of the lesion with fluorescein in the arterial phase; pronounced spotting in the venous and subsequent phases. has unclear boundaries and resembles tiger skin; deep neovascularization small vessels; superficial microneovascularization; fluorescence lasting for several hours; glow of collateral dilated vessels of the tumor; pathological macrovascularization (presence of large intratumoral vessels). The presence of 5 of the 8 listed signs indicates the presence of melanoma.
Central serous chorioretinopathy Acute loss of vision, sometimes after surgery viral infection Complaints, anamnesis, ophthalmoscopy, perimetry, refractometry, OST, FA The decrease in vision is slight. The appearance of hypermetropia, which was not there before. In the field of view there is a central relative scotoma. With ophthalmoscopy, there is a disc-shaped serous detachment in the macular area, limited by the arc reflex, the macular reflex is blurred, often absent, within the serous detachment there are grayish or yellowish dots - precipitates on the posterior surface of the retina (Baer's precipitates). In red-free light, the color of the edema zone becomes darker than the rest of the fundus, and the edge of the edema is more clearly visible. FAH - The phenomenon of darkening (hypofluorescence) of the zone of serous detachment in the early phases, the presence of leakage points (defects in the detached epithelium). When fluorescein is supplied in an amount insufficient to stain a large area of ​​detachment, the leakage point is visible as a speck. With more intensive intake it turns into a strip.
The presence of a disc-shaped headlight-in-the-night spot is clear evidence of pigment epithelial detachment. OST - presence of subretinal fluid, neuroepithelial detachment.
Acute multifocal placoid epitheliopathy Decreased vision after a viral infection, central and paracentral scotomas, possible metamorphopsia, photopsia. Complaints, anamnesis, ophthalmoscopy, OST, FA Bilateral defeat. The disease is accompanied by transient headache, aseptic meningitis, disorders cerebral circulation, due to cerebral vasculitis. On ophthalmoscopy, multiple large plaque-like foci of grayish-white or cream color at the level of the pigment epithelium, with clear contours, are located in the posterior pole and spread to the post-equatorial zone. On OCT, changes are localized at the level of the outer layers of the retina (retinal pigment epithelium and at the level of photoreceptors). At FAG -
foci of hypofluorescence in the early phase, staining is gradual and non-simultaneous, there may be a delay in choroidal fluorescence.
Hyperfluorescence in late phases, persists on delayed images. In the presence of serous detachment of the neuroepithelium, the dye spreads diffusely beyond the foci.
Subretinal and subchoroidal hemorrhages A sharp decline vision. There is a scotoma in the field of view. Ophthalmoscopy reveals the presence of a lesion with unclear contours. Occurs in people suffering from hypertension. With ophthalmoscopy, there is a prominence of the lesion without clear boundaries, a rapid increase in its size. Positive dynamics against the background of resolving therapy for hemorrhage. On FA - hypofluorescence in the area of ​​hemorrhage - absence of luminescence of the choroidal vessels with preserved patency of the retinal vessels.
Hemorrhagic retinal detachment Sharp decrease in vision, scotoma in the field of vision. Ophthalmoscopy reveals a pathological focus on the retina. History, perimetry, ophthalmoscopy, OST, FA. On ophthalmoscopy, a prominent lesion is grayish-green in color. Rapid resorption of the pathological focus against the background of resorption therapy. OCT shows serous detachment of the pigment epithelium. On FA, there is a focus of hypofluorescence in the affected area.

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Treatment

Drugs (active ingredients) used in treatment
Amoxicillin
Acetazolamide
Acyclovir
Valacyclovir
Dexamethasone
Diclofenac
Indomethacin
Ketoconazole
Clindamycin
Levofloxacin
Lincomycin
Meloxicam
Methylprednisolone
Methotrexate
Moxifloxacin
Prednisolone
Spiramycin
Tobramycin
Tropicamide
Phenylephrine
Fluconazole
Fluorouracil
Furosemide
Cefotaxime
Ceftriaxone
Cyclosporine
Cyclophosphamide
Ciprofloxacin

Treatment (outpatient clinic)


OUTPATIENT TREATMENT**

Treatment tactics**

Non-drug treatment: (in the absence of systemic disease):
· general mode;
· diet No. 15.

Drug treatment:

: to dilate the pupil

or



or

or

or

Antibacterial:










Antiviral agents:

or

Antifungal agents:

or

Diuretics indicated for inflammatory processes occurring with ocular hypertension or secondary glaucoma. Carbonic anhydrase inhibitor; increases renal excretion of bicarbonates from the body. At long-term treatment Prescription of potassium supplements or a potassium-sparing diet is required.
. Acetazolamide 0.25 g orally 1 time per day; [B]
. or

. or



or

or

Cytostatic agents:

Antimetabolites:
methotrexate 0.005; 0.05; 0.1 g - solution of 0.03 in the sub-Tenon space every other day 4-5 times [V]
or
5-fluorouracil 1.0 g - solution 0.03 in the sub-Tenon space every other day 4-5 times [B].
IN severe cases:
Cyclosporine 50 mg, 100 mg 2 times a day for 3-6 months, with a gradual dose reduction [C]
or
Cyclophosphamide 50 mg 2 times a day for 2-6 months [C]

Other treatments: no.

Basic:
consultation with a therapist - for assessment general condition body, eliminating chronic inflammatory and systemic diseases;
· consultation with an otorhinolaryngologist - if inflammation in the maxillary or frontal sinus is suspected;
· consultation with a dentist - for chronic, unsanitized inflammatory processes in the oral cavity;
· consultation with a rheumatologist - to exclude systemic diseases in case of positive rheumatology tests.

Additional:
· consultation with a nephrologist - to exclude kidney pathology;
· consultation with a neurologist - to exclude diseases of the nervous system;
· consultation with a dermatovenerologist - to exclude dermatovenerological pathology;
· consultation with a phthisiatrician - in case of torpid, recurrent course of the process, resistant to standard therapy; indication of a history of tuberculosis to exclude tuberculosis of the eyes;
· consultation with an infectious disease specialist - to exclude infectious lesions accompanied by chorioretinal inflammation, if the results of blood tests for infections are positive.

Preventive actions:
. timely detection and sanitation of chronic foci of infection;
. maintaining visual hygiene;
. sanitation of lesions chronic infection.

Patient condition monitoring**:
Outpatient observation by an ophthalmologist at the place of residence after treatment: 1 time per week - the first month; 1 time per month - the first 3 months; Once every 6 months - within 2 years. Monitoring the patient's condition includes mandatory visometry, biomicroscopy, ophthalmoscopy, tonometry, and perimetry.


. increased visual acuity;
. cupping inflammatory process;
. resorption of infiltrate;
. reduction of fibroplastic changes;
. reduction of scotomas, photopsia in the field of view;
. reduction of object distortion.

Treatment (inpatient)


INPATIENT TREATMENT**

Treatment tactics**:
Treatment of the disease is purely individual, its effectiveness largely depends on the timeliness of prescriptions. Local therapy for any type of disease, even with focal chorioretinitis, is ineffective; parabulbar or retrobulbar injections are more effective.

Non-drug treatment:
Regime - III B, diet No. 15 (in the absence of systemic disease).
Drug treatment (depending on the severity of the disease):

List of main medicines:

Mydriatics and cycloplegics for pupil dilation: to dilate the pupil
· tropicamide 1% 2 drops 1-3 times a day, 5-7 days [B]
or
· phenylephrine 1% 2 drops 1-3 times a day, 5-7 days [B]

Glucocorticosteroid drugs:
. Dexamethasone 0.1% 2 drops 3-6 times a day, to block inflammation as a result of stabilizing lysosome membranes, reducing the permeability of capillary endothelium, inhibiting the migration of leukocytes and phagocytes, inhibiting the synthesis of prostaglandins, also this drug significantly slows down proliferation. [IN]
or
. Dexamethasone 0.4% 1.2-2 mg is prescribed once a day subconjunctivally or 2-2.8 mg parabulbarly; to block inflammation as a result of stabilizing lysosome membranes, reducing the permeability of capillary endothelium, inhibiting the migration of leukocytes and phagocytes, inhibiting the synthesis of prostaglandins, and this drug also significantly slows down proliferation. [IN]
or
. Prednisolone 5 mg 30-80 mg per day orally in the first half of the day, followed by a dose reduction for 10 days, is used for frequently recurrent processes, systemic and syndromic diseases. [IN]
or
. Methylprednisolone 250-1000 mg once a day for 3-5 days intravenously, if ineffective local therapy, severe chorioretinal inflammation, threatening vision loss, bilateral damage in systemic and syndromic diseases. [IN]

List of additional medicines:

Antibacterial: for infectious etiology (drug of choice):
· tobramycin 0.3%, 2 drops 4-6 times a day [B];
· ciprofloxacin 0.3%, 2 drops 4-6 times a day, 7-10 days [B];
Levofloxacin 2 drops 4-6 times a day for 7-10 days [B];
· moxifloxacin 2 drops 4-6 times a day for 7-10 days [B];
· ciprofloxacin 250, 500 mg, 1g each. per day orally 7-10 days [B];
· amoxicillin 250, 500 mg, 1g. per day orally for 14 days [B];
clindamycin 150 mg 4 times a day orally for 7-14 days [B];
· spiramycin 150 mg 4 times a day orally for 7-14 days [B];
ceftriaxone 1 g, 1 g 1-2 times a day intramuscularly for 7-14 days [B];
· lincomycin 30% -600 mg 2 times a day intramuscularly for 7-10 days [B];
· cefotaxime 1g, 2 g, 1-2 g each. 2 times a day for 5-7 days [B].

Antiviral agents: prescribed for chorioretinitis caused by a viral infection:
. acyclovir 200 mg 5 times a day for 5-7 days [B];
or
. valacyclovir 500 mg 2-3 times a day for 5-7 days [B].

Antifungal agents: prescribed for chorioretinitis caused by fungal infection:
. fluconazole 150 mg 1-3 times a day for 10 days [B];
or
. ketoconazole 200 mg 1-2 times a day orally, 7-14 days [B].

Diuretics indicated for inflammatory processes occurring with ocular hypertension or secondary glaucoma. Carbonic anhydrase inhibitor; increases renal excretion of bicarbonates from the body. Long-term treatment requires the use of potassium supplements or a potassium-sparing diet:
. Acetazolamide 0.25 g orally once daily; [B]
. or
. Furosemide 40 mg once a day for 3 days;
. or
. Furosemide 1% 2 ml intramuscularly once a day for 1-3 days. [B]

Non-steroidal anti-inflammatory drugs: inhibit the biosynthesis of prostaglandins and other anti-inflammatory factors.
. Indomethacin 25 mg 3 times a day for 14 days; [WITH]
or
. Diclofenac sodium 25 mg, 75 mg 1 time per day intramuscularly, 3-7 days; [WITH]
or
. Meloxicam 15 mg 1 time per day intramuscularly, 3-7 days. [WITH]

Cytostatic agents:
Indicated for frequently recurrent uveitis with systemic and syndromic diseases, ineffectiveness of glucocorticosteroid therapy.

Antimetabolites:
methotrexate 0.005; 0.05; 0.1 g - 0.03 per sub-Tenon’s space every other day 4-5 times [V]
or
· fluorouracil 1.0 g - 0.03 in the sub-Tenon's space every other day 4-5 times [B].
In severe cases:
· cyclosporine 50 mg, 100 mg 2 times a day for 3-6 months, with a gradual dose reduction; [WITH]
or
· cyclophosphamide 50 mg 2 times a day for 2-6 months. [WITH]

Surgical intervention: not indicated.

Other treatments: no.

Indications for consultation with specialists:
· consultation with a therapist - to assess the general condition of the body, exclude chronic inflammatory and systemic diseases.
· consultation with an otorhinolaryngologist - if inflammation in the maxillary or frontal sinus is suspected.
· consultation with a dentist - to exclude chronic inflammatory processes in the oral cavity.
· consultation with a rheumatologist - to exclude systemic diseases.
· consultation with a nephrologist - to exclude kidney pathology.
· consultation with a neurologist - to exclude diseases of the nervous system.
· consultation with a dermatovenerologist - to exclude dermatovenerological pathology.
· consultation with a phthisiatrician - to exclude tuberculous eye damage
· consultation with an infectious disease specialist - to exclude infectious lesions accompanied by chorioretinal inflammation.

Indications for transfer to the department intensive care and resuscitation: no.

Indicators of treatment effectiveness:
· improvement of visual acuity;
· relief of the inflammatory process;
· resorption of infiltrate;
· reduction of fibroplastic changes;
· reduction of scotomas, photopsies in the field of view;
· reduction of distortion of objects.

Hospitalization


Indications for planned hospitalization: none.

Indications for emergency hospitalization:
. active inflammatory process;
. ineffectiveness of outpatient treatment, negative dynamics during therapy;
. threat of generalization of the inflammatory process.

Information

Sources and literature

  1. Minutes of meetings of the Joint Commission on the Quality of Medical Services of the Ministry of Health of the Republic of Kazakhstan, 2016
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Information


Abbreviations used in the protocol:

HIV - AIDS virus
HSV - herpes simplex virus
DZN - optic disc
ZN - optic nerve
ELISA - linked immunosorbent assay
MRI - Magnetic resonance imaging
UAC - general blood analysis
OAM - general urine analysis
OST - optical coherence tomography
USDG - Doppler ultrasound
Ultrasound - ultrasonography
FAH - fluorescein angiography
CMV - cytomegalovirus infection

List of protocol developers:
1) Aldasheva Neilya Akhmetovna - doctor medical sciences, Kazakh Research Institute of Eye Diseases JSC, Deputy Chairman of the Board for strategic development and science.
2) Doshakanova Asel Baidauletovna - Candidate of Medical Sciences, JSC “Kazakh Research Institute of Eye Diseases”, head of the department of strategy for the development and organization of ophthalmological services.
3) Stepanova Irina Stanislavovna - Doctor of Medical Sciences, JSC “Kazakh Research Institute of Eye Diseases”, senior lecturer in the department of postgraduate education.
4) Doszhanova Bakyt Sagatovna - State Public Enterprise at the RPV “Zhambyl Regional Ophthalmological Center”, Health Department of the Zhambyl Region, Deputy Chief Physician, Chief Freelance Ophthalmologist of the Zhambyl Region.
5) Azhigalieva Mayra Narimanovna - Candidate of Medical Sciences, JSC "Kazakh Research Institute of Eye Diseases", doctor of the consultative and rehabilitation department.
6) Khudaybergenova Mahira Seidualievna - JSC National Scientific Center of Oncology and Transplantology, clinical pharmacologist.

Conflict of interest: absent.

List of reviewers: Utelbaeva Zauresh Tursunovna - Doctor of Medical Sciences, RSE at the PVC "Kazakh National medical University named after S.D. Asfendiyarov”, professor of the department of ophthalmology.

19. Conditions for reviewing the protocol: review of the protocol 3 years after its publication and from the date of its entry into force or if new methods with a level of evidence are available.

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Chorioretinitis of the eye is an inflammation of the posterior part of the choroid of the eyeball. The process may also involve the retina. The disease occurs in acute and chronic forms. It can be either congenital or acquired during life.

Toxoplasmosis chorioretinitis is considered congenital and infection occurs inside the mother's womb. Manifestations of the disease will not always be noticeable at birth or at an early age; they can make themselves felt much later. Along with eye damage, other disorders also occur. Most often the nervous system is affected.

Usually to formation of this disease gives several conditions:

  1. Tuberculosis, syphilis, herpes, infections of the oral cavity and respiratory organs.
  2. Radiation.
  3. Intoxication of the body.
  4. Allergic reactions.
  5. A condition in which a person’s immunity is weakened; this can be observed after prolonged treatment and in carriers of the HIV virus.
  6. Eye injuries.

Chorioretinitis is posterior uveitis

Main symptoms

Central serous chorioretinitis can manifest itself in different ways, it all depends on the location. Only an experienced doctor will be able to understand the cause and prescribe treatment.

Central chorioretinitis is characterized by disturbances in the macular zone. Lesions of the eye may be observed near the optic nerve, dentate line, or equator. Chorioretinitis can be multifocal, focal, diffuse.

Depending on these characteristics, the patient develops characteristic symptoms. In some cases, the process is asymptomatic and the person does not complain about anything. In this case, any violations can be detected only through careful diagnosis.

  1. If the disease does make itself felt, then vision noticeably deteriorates.
  2. The picture before my eyes is no longer as clear as before.
  3. A shroud, glare, flashes, and dark spots may appear.
  4. In some cases, objects in front of your eyes may be visually distorted.
  5. Navigating at night becomes more difficult every day.

If you have several of these symptoms, you should immediately consult a doctor for help.

With toxoplasmosis chorioretinitis, scarring may be observed; white lesions indicate the presence of inflammation. In the acute period, it is difficult to notice such changes; their boundaries are unclear.

When the process is active, it is possible serious consequences- retinal detachment, thickening of tissues, they have a gray or yellowish tint.

Clinical characteristics

This disease is rarely acquired during life; most often this pathology is congenital. This is due to an infection that was transmitted to the baby inside the womb. This form almost always affects not only vision, but also other internal organs.

The central nervous system is most at risk. Like any chronic disease, chorioretinitis is accompanied by exacerbations and remissions, when the patient feels noticeably better.

The foci of the disease are not vague, they are clearly defined, have coarse pigmentation and have clear boundaries. In some cases, damage may not be noticeable, but this does not mean that it is absent.

When the disease reappears after remission, new manifestations may be in the same place. New processes may resemble vitreous humor. The process of retinal detachment and hemorrhage is quite dangerous and can lead to the formation of a neovascular membrane.

If the cause of the disease is syphilis, the clinical picture will be heterogeneous. Pigmentation and areas of fibrosis may alternate and overlap. In tuberculosis, the manifestations of lesions are always secondary.

Primary changes are not on visual organ, but on the lungs. After treatment, scars may form at the site of the lesions. Manifestations of the disease associated with tuberculosis do not have any special distinctive features.

Chorioretinitis due to HIV infection occurs due to weakening immune system. The clinical picture is pronounced. The lesions are extensive and difficult to treat. There is a high risk of losing your vision completely.

Diagnostics

It is impossible to diagnose the disease on your own. Changes that can be seen with the naked eye do not always indicate the presence of chorioretinitis. In addition, at first the symptoms are mild, so without medical diagnostics not enough.

To confirm or refute the diagnosis, a set of measures is carried out:

  1. The doctor checks visual acuity. With chorioretinitis, vision always deteriorates.
  2. Computer perimetry. Helps to identify how much the sensitivity of the retina is reduced and whether dark spots are present.
  3. Biomicroscopy. This procedure helps determine whether changes are present in the vitreous.
  4. Transmitted light examinations will help identify the presence of opacities.
  5. Ophthalmoscopy. Helps to examine even the deepest lesions. This happens with the help of a special lens. This helps to see clear boundaries of the lesion and identify pigmentation.
  6. Vascular changes are determined using angiography.
  7. Electroretinography diagnoses the condition of the retina.
  8. Using optical tomography, the doctor determines the intensity of inflammation.
  9. Cloudiness on the eyeball and other changes can be detected after an ultrasound.

Additionally, you need to take a blood and urine test. It is necessary to confirm or refute the presence of hepatitis, syphilis, HIV infection, herpes. All this helps to determine a blood test. Fluorography checks the condition of the lungs. The Mantoux test must be performed if there are indications for this.

If necessary, you should consult an allergist, venereologist, dentist, therapist and some other doctors.

Treatment used

Treatment of chorioretinitis should be carried out in a timely manner and always individually. Usually the patient is prescribed injections and local therapeutic procedures. In addition, a number of additional drugs are prescribed:

  1. Etiotropic. Medicines are aimed at eliminating the main causes of the disease. In order to identify the pathogen, the specialist prescribes a broad-spectrum antibiotic. If there is a viral infection in the body, the patient takes antiviral drugs. Antibiotics of the penicillin group are effective if the cause of the disease is syphilis. Usually the course of treatment is 1 month. Under treatment folic acid and sulfadimezine. For disorders caused by tuberculosis, a TB doctor is needed.
  2. The disease can be treated with anti-inflammatory and hormonal medications intramuscularly, intravenously or orally.
  3. In case of poisoning and detection of toxins, detoxification is carried out.
  4. In case of weakened immunity, immunostimulants are taken. The patient needs to lead a healthy and active lifestyle, eat right, eat foods that boost immunity, and spend more time in the fresh air.
  5. To strengthen the body's resistance, vitamins C and B are prescribed.

Additionally, enzymes are taken that accelerate the resorption of the inflammation. Physiotherapeutic procedures promote recovery. Laser coagulation is necessary to limit the source of inflammation. For retinal detachment, vitrectomy is performed.

The dose of drugs depends on clinical picture. For chorioretinitis, treatment should be carried out comprehensively, only then can positive results be obtained.

Conclusion

Chorioretinitis is dangerous disease. In the absence of proper treatment, it is possible to get retinal detachment, retinal bleeding, and complete loss of vision. In order to avoid such consequences, it is important to diagnose the disease in time and begin drug and therapeutic treatment.

Video

IN last years, an eye disease such as chorioretinitis is becoming increasingly common. We can say that it consists of two diseases - retinitis and choroiditis. At the beginning of the development of the disease, the inflammatory process begins in the posterior vascular membrane.

Since the choriocapillary vessels are connected to the entire retina, problems and inflammation in them will affect the entire retina. Therefore, the disease chorioretinitis spreads to the entire eye.

Moreover, the causes of the disease are very diverse. These include viral and bacterial forms. This disease can also appear as a result of systemic diseases: HIV, syphilis, etc.

The problem of this disease is that the symptoms, regardless of the complexity of the disease, are very serious, the course is problematic and severe. It can cause huge complications of eye diseases. Such as hemorrhage in the vitreous body, retinal clouding, as well as other equally painful problems. These complications lead to deterioration of vision, and also when the cases are particularly severe, its complete loss, subsequently, total loss ability to work.

Today, acute and chronic forms of chorioretinitis are distinguished. Depending on when it appeared and under what circumstances, the disease can be congenital or acquired.

Toxoplasmosis chorioretinitis is more common congenital. The child becomes infected while still in the womb. This type also affects nervous system. Retinal detachment is common, with old lesions visible compared to new growths.

Infectious diseases often occur after eye damage: trauma, severe hypothermia. Allergies, flu, meningitis - all of these can also be the cause of the development of chorioretinitis.

Causes of chorioretinitis

  1. Infection (HIV, syphilis, tuberculosis) also includes local infections (oral cavity, nose, etc.) in this category.
  2. Radiation exposure.
  3. Toxic contamination (decomposed blood particles).
  4. Allergies.
  5. Autoimmune diseases.
  6. Injuries, hypothermia.
  7. Immunodeficiency (after suffering from HIV or other serious illnesses).

Symptoms of chorioretinitis

The initial warning sign of serous chorioretinitis is mild blurred vision. And after a couple of days, a dark spot appears before the eyes. Sometimes a symptom such as a change in the patient’s perception of colors is noted.

At first, no severe stages, patients note flashes of light before their eyes, vision decreases, this is typical for the purulent form.

Develops " night blindness» — poor eyesight during darkness and darkness, metamorphopsia. Feels like strong pain in the affected eye, clouding of the retina. High threshold photosensitivity, spots before the eyes.

In the anterior part of the eye, symptoms as such are not observed, while the posterior part undergoes changes, and may also occur in several foci.

Focal chorioretinitis is possible in the center of the posterior part of the eye (central serous chorioretinitis), on its periphery. Sometimes there is a possibility of damage to other parts of the eye. These include the equatorial or peripapillary form of the disease. The signs of this disease are determined by the location of the source of the disease.

Regardless of which of the above forms and types of disease the patient has, he must consult a doctor. This is a serious, complex disease, it will bring dire consequences in the absence of proper treatment.

Possible diagnosis of chorioretinitis

The peculiarity of this disease is that it is difficult to determine on its own, and as soon as a diagnosis is made, it is necessary to urgently begin treatment. But you cannot make your own conclusion; only an experienced specialist can do this, and then prescribe the appropriate treatment.

The conclusion of chorioretinitis can be made due to the patient’s complaints, as well as after additional studies, such as ophthalmoscopy, FAGD, blood tests, remitry to identify dark spots, biomicroscopy to determine deformations in the vitreous body, the use of a Goldmann sleeve in ophthalmoscopy and a complete examination of the patient. But, unfortunately, even these measures do not always lead to the correct medical conclusion.

Treatment of chorioretinitis

Drug treatment of chorioretinitis

Treatment for this disease is long-term. It requires a careful approach to treatment, as well as scrupulousness in matters of one’s health. It is very dangerous, so it should not be left to chance. In case of inattention, unwillingness to follow the doctor’s instructions, or a disregard for the disease, vision loss or even complete incapacity of the damaged eye is likely.

Basically, anti-inflammatory and antiallergic drugs are prescribed for treatment. Since the problem is with capillary impermeability, medications are prescribed to improve this function. Antibiotics, physiotherapy, ultrasound therapy, and magnetophoresis are often used.

Due to the fact that the main cause of chorioretinitis is the consequences of other diseases, treatment should be aimed primarily at eliminating the root cause.

Common and effective method treatment is laser. It eliminates blocking defects in the basal plate. But it is worth noting that laser coagulation also has negative aspects, such as: severe swelling of the eye, which will not go away for about 7 days. This method is also used in cases where the patient’s symptoms are not clearly expressed.

Folk remedies for eliminating chorioretinitis

This disease is very serious and dangerous, but you can try to treat it with a variety of herbs and folk remedies. There is a large group of natural plants capable of dilating blood vessels. But let us immediately note that this is not the main treatment, but just an addition to drug treatment and prescribed by a doctor.

Recipes for brewing herbs.

  • Pour 10 g of valerian root into a cup of boiling water, boil for half an hour, then let it brew for about half an hour. Take the resulting product 10 g several times a day.
  • Hawthorn fruits are also excellent in treating such diseases. To prepare the medicine you need: 20 g of fruit, pour a cup of boiling water over it, and let the resulting liquid infuse. Take 10 g several times a day half an hour before meals or an hour after.
  • Hazel bark perfectly dilates blood vessels. To prepare it, take 10 g of bark, pour in 0.25 liters of boiling water, let it stand for 2 hours and use 10 g several times a day.

Prevention of chorioretinitis

First of all, general hygiene and caring for your body. It is necessary to ensure that diseases that subsequently develop chorioretinitis do not appear, or to treat them quickly and efficiently; these are infectious and immunodeficiency diseases. It is important to diagnose them in a timely manner and, if they occur, to provide high-quality treatment. It is important to sanitize such groups of organs as the ENT, as well as the oral cavity.

If you behave correctly with your body, avoid hypothermia and hygiene, you do not need to be afraid of this disease.

Date: 03/07/2016

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Central chorioretinitis is an eye disease. There are several varieties of this disease. Each of them is accompanied characteristic symptoms and has its reasons.

Central serous chorioretinitis: the essence of the problem

This is an inflammatory process that occurs in the posterior part of the choroid and affects the retina. There are 4 forms of this disorder:

In addition, there are other forms of the disorder: depending on the severity of the course - acute and chronic, depending on the method of manifestation - congenital and acquired.

The disease is accompanied by characteristic symptoms.

The first sign that indicates the onset of the disease is blurred vision, and after a few days - the appearance of a dark spot before the eyes, in some cases - impaired color vision. In addition, the following symptoms are characteristic:

  • decreased visual acuity, especially at dusk;
  • distorted vision;
  • the retina becomes cloudy;
  • photophobia;
  • painful sensations in the organs of vision.

The disease is preceded by certain causes.

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Causes of the disease

The most common reasons are the following:

  • tuberculosis, then tuberculous chorioretinitis is diagnosed;
  • syphilis;
  • hypothermia;
  • eye injury;
  • violations intrauterine development, then congenital chorioretinitis is diagnosed;
  • complications after past diseases: flu, meningitis, pneumonia;
  • allergic reactions for radiation, intoxication, etc.;
  • slow blood flow, in which the bed of blood vessels becomes wide, as a result of which vascular metastases develop.

As a result of one of these reasons, an eye infection may occur.

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Methods of treating the disease

Treatment of chorioretinitis must be carried out, otherwise it can cause significant visual impairment. The goal of therapy is to eliminate the cause that provoked the development of the disease. Therapy includes the following activities:

Drug therapy. Ophthalmologists prescribe the following groups of drugs:

  • anti-inflammatory;
  • antiallergic;
  • drugs that normalize capillary permeability;
  • antibiotics.

Physiotherapy. Laser coagulation has proven its effectiveness in eliminating defects in the basal lamina.

At the first atypical symptoms, you should consult an ophthalmologist, since the disease can cause retinal detachment, retinal hemorrhage, blockage of the retinal veins and others serious violations, up to blindness.

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Toxoplasmosis chorioretinitis

The disease usually develops as a result of intrauterine infection. In most cases, congenital chorioretinitis is diagnosed. It is accompanied by characteristic symptoms:

  1. All the symptoms that accompany serous chorioretinitis.
  2. Chorioretinal lesions, which are located at the posterior pole of the eye. They are large in size and can be atrophic or cicatricial. This symptom is observed during the inactive stage of the disease.
  3. Outbreaks white, which can be located in any area of ​​the fundus, but usually appear on the border of old lesions that arose during the inactive stage. This sign indicates that the disease is in an active phase.
  4. Lesions without clear boundaries and can be of any size. In this case, closure of blood vessels in the area is possible. This is a sign acute period inflammatory process.
  5. Pathological changes in the vitreous body, infiltration of the layers of the vitreous body with a cell suspension, the formation of membranes - all these are indicators that the destructive process has spread to the inner layers of the retina, and the halogen membrane has begun to collapse.

It is worth noting that treatment is not always indicated for the patient. If the lesions are small in size and the disease is asymptomatic, then self-healing is possible: within six months these lesions can resolve on their own. If the lesions are pronounced or reactivation of the inflammatory process is observed, treatment is necessary. Its goal is to destroy microorganisms that cause inflammation. Therapy includes the following activities.

– inflammation of the posterior choroid and retina. The main symptoms of the disease: the appearance of “floaters” and “floaters” before the eyes, impaired dark adaptation, decreased vision, photopsia, macro- and micropsia. Diagnosis is based on bacteriological culture, ELISA, determination of C-reactive protein, gonioscopy, angiography, perimetry, and ophthalmoscopy. Conservative therapy includes the prescription of antibacterial agents, non-steroidal anti-inflammatory drugs, mydriatics, glucocorticosteroids, biogenic stimulants and reparants.

General information

Chorioretinitis is a common pathology among Caucasians. Inflammation of the anatomical structures of the uveal tract is possible at any age, but most often occurs in people over 40 years of age. The ratio of disease prevalence among women and men is 2.3:1. In 22% of patients, there is a hidden lesion of the choroid (the absence of depigmented lesions during the first examination of the fundus). According to statistics, the average duration of the disease before diagnosis is 3 years. Chorioretinitis of the “shot shot” type is more often diagnosed in residents Northern Europe.

Causes of chorioretinitis

  • Infectious diseases. The disease often occurs against the background of tuberculosis and syphilis. If the pathology is tuberculous in nature, lesions of different ages, which differ in color, are ophthalmoscopically identified. With syphilis, changes in the posterior part of the eyes are less pronounced.
  • Traumatic injuries. In post-traumatic genesis, the inflammatory process is preceded by ruptures of the choroid and hemorrhages into the suprachoroidal space. In most cases, it is possible to identify the entrance gate of infection. Chorioretinitis is combined with damage to the anterior segment of the eyes.
  • Focal infections. Pathological agents can spread hematogenously in the presence of a focus of acute or chronic infection in the oral cavity, orbit, or damage to the ENT organs. The causative agent is usually pyogenic strains of bacteria.
  • Toxoplasmosis. The pathogen is able to penetrate into the posterior segment of the eyeball by hematogenous route. The most common cases of intrauterine infection. The pathology is often combined with other eye malformations (anophthalmos, microphthalmos).

Pathogenesis

In the mechanism of development of the disease, the leading role is given to the influence of bacterial toxins, which trigger allergic reactions, and, less often, an autoimmune process. Bacteria or viruses can penetrate the structures of the uveal tract through endogenous or exogenous routes. Predisposing factors to the development of pathology are anatomical (wide vascular bed) and hemodynamic (slow blood flow) structural features. The retina is the first to be affected. The spread of pathological agents into the choroid occurs secondary. Atrophy of the anatomical formations of the uveal tract occurs due to impaired blood supply, which normally occurs due to the choriocapillary vessels. There are non-granulomatous and granulomatous types of the inflammatory process.

Classification

According to the nature of the course in ophthalmology, acute and chronic form inflammation. Depending on the location of the affected area, panuveitis, peripheral and posterior uveitis are distinguished, which are divided into focal, multifocal, disseminated, neurochorioretinitis and endophthalmitis. According to activity, chorioretinitis is classified into the following stages:

  • Active. Characterized by a progressive decrease in visual acuity. Patients note increased fatigue when performing visual work, which is combined with a deterioration in well-being.
  • Subactive. Occupies an intermediate position between the active and inactive stages. It is detected during an infectious process of another localization. Clinical symptoms are mild. With absence timely treatment becomes chronic.
  • Inactive. There are no signs of inflammation. Ophthalmoscopy reveals chronic foci of infection of dense consistency. Patients report persistent visual dysfunction that does not progress. The inactive stage is an incidental finding.

In the classification according to the localization of the inflammatory process, central and peripheral forms are distinguished. Diffuse and focal damage to the uveal tract is possible. Pathological foci can be single or multiple.

Symptoms of chorioretinitis

Patients complain of progressive vision loss. The severity of visual dysfunction varies widely. Patients note the appearance of floating spots, “fog” or “veil” before the eyes. When individual lesions are located on the periphery of the choroid, visual acuity in daytime not reduced, but at dusk visual dysfunction increases. When the optical media of the eyeball become clouded, patients develop a myopic type of clinical refraction. A common symptom is the appearance of “cloudness” or “floaters” before the eyes.

In the case of a severe course, loss of certain areas of the visual field and photopsia are noted. The development of micro- and macropsia leads to distortion of objects before the eyes. Many patients indicate that the appearance clinical symptoms preceded by infectious, systemic and autoimmune diseases. Less commonly, chorioretinitis occurs after surgery on the eyeball or orbit. Visually, no pathological changes are detected. Due to the fact that visual acuity can remain normal for a long time, diagnosis is often difficult.

Complications

Increased exudation leads to the development of ocular hypertension, and secondary glaucoma occurs less frequently. Purulent chorioretinitis is complicated by optic neuritis. The accumulation of exudate and the organization of purulent masses lead to the development of pan- and endophthalmitis. Retinal atrophy is often preceded by retinal rupture or detachment. Massive hemorrhages cause hyphema and hemophthalmos. When the photoreceptors in the inner lining of the eye are damaged, color vision is impaired. Most patients have hemeralopia. In prognostic terms, the most unfavorable complication is complete blindness.

Diagnostics

The diagnosis is based on anamnestic data, the results of instrumental and laboratory research methods. An objective examination does not reveal pathological changes. This is an important criterion that allows you to differentiate chorioretinitis from pathology of the anterior pole of the eyeball. Laboratory diagnostics comes down to:

  • Bacteriological culture. The material for the study is a biopsy of the orbital conjunctiva or conjunctival fluid. The purpose of the method is to identify the pathogen and determine sensitivity to antibacterial therapy.
  • Enzyme-linked immunosorbent assay (ELISA). The study of antibody titer (Ig M, Ig G) is used to detect pathogens of chlamydia, herpes simplex, toxoplasmosis, and cytomegalovirus. ELISA allows you to assess the stage of activity of the inflammatory process.
  • C-reactive protein test. Detection of protein in the blood makes it possible to exclude or confirm the autoimmune nature of the disease. At positive test Rheumatic tests are carried out for C-protein.

In order to make a diagnosis and assess the extent of the lesion, the ophthalmologist uses instrumental methods. Using visometry, a decrease in visual acuity is determined varying degrees severity with a tendency to myopic type of refraction. An increase in intraocular pressure (IOP) is observed only when moderate severity And severe course. Specific diagnostics includes:

  • Gonioscopy. An accumulation of pus is detected in the anterior chamber of the eyeball, which indicates hypopyon or exudate. Hemorrhage into the anterior chamber of the eye leads to hyphema.
  • Ophthalmoscopy. During an ophthalmoscopic examination, lesions of a grayish-yellow hue with unclear contours and pinpoint hemorrhages are visualized. Detection of a limited area of ​​white color indicates atrophy. Region macular spot pigmented.
  • Fluorescein angiography of the retina (FA). It is possible to visualize signs of retinal vasculitis. When conducting FA with contrast, dark spots are revealed at the site of accumulation of indocyanine green.
  • Perimetry. In the peripheral form of the disease, there is a concentric narrowing of the visual field. Focal damage leads to the loss of small areas from the field of view.

Differential diagnosis is carried out with macular degeneration and malignant neoplasms choroid. Unlike a tumor, chorioretinitis reveals a perifocal focus of inflammation with blurred ridges. With dystrophic changes in the macula, there are no signs of inflammation and opacification of the vitreous body. If the origin of the disease is traumatic, radiography of the orbit is performed, which makes it possible to identify pathological changes in the retrobulbar tissue and bone walls of the orbit (fracture, displacement of debris).

Treatment of chorioretinitis

Etiotropic therapy is based on the treatment of the underlying disease. In case of traumatic etiology, it is necessary to carry out surgical intervention, which is aimed at plasticizing the bone wall of the orbit, comparing displaced fragments. Before surgery and early postoperative period a short course of antibiotics is indicated. Conservative therapy comes down to the following:

  • Nonsteroidal anti-inflammatory drugs. They are used to relieve the inflammatory process. Patients undergo daily instillations 5-6 times a day. In complicated cases, retrobulbar administration is indicated.
  • Midriatikov. M-anticholinergic blockers and sympathomimetics are used to prevent the formation of synechiae and to improve the outflow of aqueous humor. Timely administration of mydriatics reduces the risk of developing glaucoma.
  • Hormonal drugs . Indication for use: acute chorioretinitis. Patients undergo installations or subconjunctival injections of hydrocortisone. Additionally, you can apply hydrocortisone ointment under the eyelid 3-4 times a day.
  • Antibiotics. Antibacterial therapy is carried out in cases of toxoplasmosis in nature of chorioretinitis, as well as in the case of bacterial complications. If the effect is insufficient, sulfonamides are additionally indicated.
  • Reparants and biogenic stimulants. Drugs in this group promote retinal regeneration. The feasibility of using taurine and sulfated glycosaminoglycans has been proven.

To enhance the effect of conservative treatment in the subacute period or during the chronic course of the disease, physiotherapeutic procedures are prescribed. Calcium chloride is introduced using electrophoresis, antibacterial agents, proteolytic enzymes plant origin. At the stage of pathology resolution, ultrasound therapy is used on the affected side. Regardless of the form of inflammation, the use of vitamins B, C and PP is indicated. When IOP increases, it is advisable to prescribe antihypertensive drugs.

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