Myopic chorioretinitis. Serous central chorioretinitis and other forms of the disease

Diseases of the posterior segment of the eye are very common in ophthalmic practice, they pose a serious threat to vision, central serous chorioretinopathy is one of the representatives of these diseases.

Presumably, the factors that cause the disease enter the blood vessels, causing choroiditis, and then inflammation of the retina joins - retinitis. Thus, serous central chorioretinitis is formed.

The causes of this disease are not well understood, and it is considered idiopathic. The occurrence of the disease is associated with the following factors:

• infectious diseases, including chronic gastritis caused by H.pilory;
• allergic diseases;
• toxic and vascular factors;
• tuberculosis;
• diseases of the paranasal sinuses and teeth;
• develops more often in men from 20 to 50 years.

The disease develops quite quickly. From the damaged capillaries of the choroid, plasma comes out, which accumulates between the Bruch's membrane and the neuroepithelium, causing its detachment.

Symptoms

The symptoms of CSC are in many ways similar to other retinal diseases:

1. Decreased visual acuity.
2. Metamorphopsia is the distortion of objects.
3. Deterioration in the perception of colors.
4. The appearance of translucent or dark spots in front of the eye.

Symptoms appear suddenly, most often in the morning, after waking up. In the first days of the disease, patients are concerned about blurred vision, mainly in the central regions. Lateral and night vision are not affected. Over time, with an increase in edema of the central parts of the retina, visual acuity decreases, distortion of objects appears, which leads patients to an ophthalmologist.

Diagnostics

Examination for CSC is quite complicated, often, in the absence of sufficient experience and equipment, the ophthalmologist may not see small changes on the retina. In modern ophthalmological clinics, where there is good technical equipment (OCT), central serous chorioretinitis is detected in the early stages.

The main method of examination in CSH is ophthalmoscopy in conditions of mydriasis (before examination, 1-2 drops of midriacil or atropine are instilled). On examination, the doctor sees a sharply limited retinal edema, with a slight discharge (promination) into the vitreous body due to serous edema. In the zone of retinal edema, small yellowish-gray foci of depigmentation are noted.

An accurate diagnosis can be established using a modern examination - coherence optical tomography (OCT), which allows you to get a cut of all layers of the retina and the adjacent vitreous body. During OCT, all layers of the retina, their detachment or delamination, the presence of cysts and holes are clearly visualized. Central serous chorioretinopathy on OCT images looks like a cavity located between Bruch's membrane and detached neuroepithelium. It is often possible to observe detachment of the pigment epithelium.

Another, no less reliable method of examination is fluorescein angiography. This is a more dangerous procedure, since a special substance is introduced into the bloodstream. In places where there is retinal edema, due to the release of plasma along with fluorescein, a characteristic glow appears.

Treatment

Central serous chorioretinopathy requires complex treatment, which includes:

Previously, corticosteroid drugs (dexamethasone 0.1%) were actively used for treatment, but multiple studies have shown that they can increase retinal edema, as well as increase intraocular pressure, so they are currently not used.

In cases where the disease cannot be eliminated within 3 months with the help of conservative treatment, laser coagulation is used. This procedure is performed on an outpatient basis and lasts no more than 10 minutes. With an argon laser, through a special lens, a beam of light cauterizes areas of the retina with severe edema, thereby “soldering” the exfoliated neuroepithelium. This procedure does not improve vision, but it helps to prevent the progression of the disorder.

Very often, central serous chorioretinopathy resolves on its own, without the use of treatment - the neuroepithelium adheres to the membrane, and vision is gradually restored to 1.0.

In cases where recovery does not occur for more than 12 months, a diagnosis is made - chronic central serous chorioretinitis. The long course of this pathology leads to a persistent and incurable decrease in vision, the appearance of central scotomas, as well as the appearance of a dangerous complication - a subretinal neovascular membrane.

Patients with central serous chorioretinitis that have arisen are usually young, professionally active people who, due to their work activities, have very little free time. When symptoms of visual impairment appear, they do not turn to an ophthalmologist at a polyclinic, but to opticians. Therefore, optometrists need to question their clients very carefully when it is difficult to select a spectacle correction, especially when hyperopic refraction appears sharply, which is typical for older people.

Similar articles

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

In addition, there are other forms of violation: 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 in front of the eyes, in some cases - a violation of color perception. In addition, the following symptoms are characteristic:

• decreased visual acuity, especially at dusk;
• "flies" and "flashes" before the eyes;
• distorted vision;
• the retina becomes cloudy;
• photophobia;
• painful sensations in the organs of vision.

The disease is preceded by certain causes.

Back to index

The most common reasons are the following:

• tuberculosis, then tuberculous chorioretinitis is diagnosed;
• syphilis;
• hypothermia;
• injury to the organ of vision;
• intrauterine development disorders, then congenital chorioretinitis is diagnosed;
• complications after past illnesses: influenza, meningitis, pneumonia;
• allergic reactions to radiation, intoxication, etc.;
• slow blood flow, in which the vascular bed becomes wide, as a result of which vascular metastases develop.

As a result of one of these causes, infection of the eye can occur.

Back to index

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

Medical therapy. Ophthalmologists prescribe the following groups of drugs:

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

Physiotherapy. Laser coagulation has proved its effectiveness, which helps to eliminate defects in the basal lamina.

At the first atypical symptoms, it is worth contacting an ophthalmologist, since the disease can cause retinal detachment, retinal hemorrhage, blockage of the retinal veins and other serious disorders, up to blindness.

Back to index

The disease develops, as a rule, due to intrauterine infection. In most cases, it is congenital chorioretinitis that is diagnosed. It is accompanied by characteristic symptoms:

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

It is worth noting that treatment is not always indicated for the patient. If the foci are small, and the disease is asymptomatic, then self-healing is also possible: in six months, these foci can resolve on their own. If the foci are expressed or the reactivation of the inflammatory process is observed, it is necessary to carry out treatment. Its purpose is the destruction of microorganisms that provoke inflammation. The therapy includes the following activities:

Medical therapy:

• nonspecific anti-inflammatory therapy with drugs of the corticosteroid group;
• specific therapy, in which drugs of the sulfonamide group and folic acid have shown their effectiveness.

https://youtu.be/qxjHChM14js

The peculiarity of the treatment of this form of the disease is the combination of nonspecific and specific therapy.

Such a complex name for an eye disease, like central serous chorioretinitis, is explained by the difficulty of its etiology. The fact is that it originates in the central part of the back wall of the vascular (serous) membrane of the eye.

Initially, the symptoms were described in detail in 1866 by the German physician A. von Graefe, where this disease was given the name - central recurrent retinitis.

The author assumed that the inflammatory process of the retina is the basis. In the modern version, the term "chorioretinitis" implies two diseases at once: retinitis and choroiditis. The first causes inflammation of the retina, and the second is characterized by inflammation of the choroid only.

However, choriocapillaries are inextricably linked with the entire retina. Therefore, with a combination of the most negative factors, the prognosis for a late-diagnosed disease is unfavorable. It can lead to a complete detachment of the retina, and, therefore, to blindness.

Scientists around the world have long wondered about the origin of the disease, trying to explain its frequency by belonging to any race, sex or age.

However, today central chorioretinitis ranks 4th among all ophthalmic pathologies of the fundus, the causes of which are very many:

• allergic;
• infectious (viral, bacterial);
• hormonal;
• toxic;
• neuronal;
• immunodeficient;
• hereditary;
• post-traumatic.

It should be noted that in middle-aged men, however, this disease is diagnosed much more often. Ophthalmologists note that among the many provoking factors, a high level of steroid hormones strongly affects the development of chorioretinitis.

The medical literature describes many facts when the disease occurred while taking corticosteroids used to treat other systemic or autoimmune diseases. In women, the use of hormone replacement drugs during menopause may be affected.

If central serous chorioretinitis is detected on time, then a positive treatment result will be provided. But the complexity is the process of diagnosing, which is possible only with special equipment in an ophthalmological clinic. Indeed, at the initial stage, a person does not immediately lose his sight. Its decrease occurs only by hundredths of units.

This is felt at an early stage by a slight misting of visible objects. After a few days, the affected eye may see a dark, blurry spot or be color blind. In bright light there is pain in the eyes, but in the dark he sees as it happens with “night blindness”.

To detect the disease at an early stage, doctors use the Gulstrand ophthalmoscope, using an additional binocular nozzle. In some cases, it is only possible to clearly establish the pathological zone in the center of the fundus using the biomicroscopy method (determines the deformation in the vitreous body). As an additional study, blood is taken for analysis, perimetry is performed to detect dark spots, FAGD (fluorescein angiography of the fundus). Sometimes optical tomography is used.

But sometimes even such a comprehensive examination of the eye does not provide information about the cause of the pathology. Only after 5 weeks from the onset of the disease on the ophthalmoscope can you see small dotted brown lesions. As they increase, they acquire a yellow tint. Experts say that these are indicators of the place where the process of retinal detachment has already begun. In some patients, 2-3 more foci of choroidal origin may be observed. They are somewhat larger than the previous ones, and are arranged in groups.

Since all changes occur on the back wall of the eyeball, outwardly, this does not manifest itself in any way, except that the sick person begins to complain of a sharp decrease in vision.

With the positive dynamics of treatment on special equipment, you can see how the puffiness on the retina gradually decreases. But in place of the areas of the once affected retina, a trace will remain in the form of altered pigmentation.

Depending on the severity of the disease, it can last from 2 weeks to 8 months. A mild course and timely treatment allow you to fully restore vision. But sometimes it is still somewhat lower after treatment than it was.

Despite many years of study of this disease, medicine still does not have a clear understanding of the etiology and pathogenesis of its development. It can be very difficult to determine the true cause of a serous lesion of the posterior wall of the eyeball, and it is the fight against the underlying disease that caused such a defect that can provide positive dynamics. Nevertheless, there is some progress in this direction.

Drug therapy includes a group of anti-inflammatory drugs (if necessary, and hormone-containing):

• Diclofenac;
• Indomethacin;
• Dexamethasone;
• Hydrocortisone;
• Prolong diprospan.

If the causes of inflammation are toxic, then detoxification agents may be needed. Their role is performed by droppers with gemodez or glucose (5%).

In immunodeficiency states - immunostimulants:

• Fluorouracil;
• Mercaptopurine;
• Levamisole (in the presence of HIV).

Anti-allergic drugs are almost always used: Suprastin, Claritin and the like, multivitamin complexes, special enzymes in the form of injections for resorption of puffiness.

Antibiotics are also needed. Which ones, is determined depending on the pathogenic flora of the causative agent of the disease and the reaction of the body. Since treatment should begin immediately, a broad-spectrum antibiotic is first prescribed, and after laboratory data are obtained, the drugs are corrected.

For example, chorioretinitis due to syphilis requires the use of a penicillin group, and the viral nature of the disease is treated with interferons. With toxaplasmosis, sulfonamides are effective in combination with folic acid, and in the tuberculosis form, phthisiatric therapy is carried out in parallel.

In addition to medicines, use:

• magnetophoresis;
• enzyme electrophoresis;
• laser photocoagulation of the retina.

Physiotherapy is necessary already at the last stage of treatment, at the stage of accelerating recovery. Coagulation is carried out when there is a need to eliminate lesions of the basal plate.

This procedure is done only in the absence of an acute course of chorioretinitis.

Only an experienced specialist can understand all the intricacies of the treatment of this complex ophthalmic disease. Therefore, there can be no talk of any self-treatment and the use of folk remedies.

A neglected form of central serous chorioretinitis can lead, if not to retinal detachment, then to blockage of its venous bed, or retinal hemorrhage. In any case, it threatens blindness. The only thing that can be used at home is plants to help traditional treatment that can dilate blood vessels.

These are:

• hazel bark;
• valerian;
• hawthorn fruit.

Valerian root and hazel bark will need 10 g, and boyar fruits 20. This amount is taken in a glass of boiling water. Only valerian should be boiled for 30 minutes, hazel should be insisted for two hours, and beetroot for an hour. Any infusion is taken in small portions - 10 ml, but several times a day (3-5). May be useful: elecampane, lily of the valley, Chinese magnolia vine.

It is useful, along with this, to increase the amount of vitamins, micro- and macroelements in the diet, to ensure a balanced diet and daily routine.

More than others, the eyes need vitamins such as riboflavin, thiamine, carotene, PP, B12, folic acid.

As a preventive measure, it is important to monitor body hygiene, as necessary, on time, to carry out therapeutic and prophylactic procedures of the oral cavity and ENT organs.

Chorioretinitis - the main symptoms:

• spots before the eyes
• Pain in the eyes
• Lightning before eyes
• Decreased visual acuity at dusk
• vision distortion
• Increased photosensitivity
• Retinal clouding

Chorioretinitis is an inflammatory disease with an acute or chronic course that affects the posterior choroid of the eye. The retina is also involved in the process. The circulatory system in the posterior part of the eye is arranged in such a way that the vessels here form a wide bed. This anatomical feature leads to a slowdown in blood circulation in this area.

For this reason, all infectious agents that enter the human body often linger precisely on the back of the eye. The inflammatory process first affects the capillaries that feed the retina with blood, and later passes to the choroid.

Etiology

The following factors can provoke the progression of chorioretinitis:

• penetration into the membranes of the eye of infectious agents;
• autoimmune pathologies;
• penetration of influenza, herpes and HIV viruses into the tissues of the eye;
• immunodeficiency states;
• eye injuries of varying severity;
• allergic reactions;
• complications of myopia;
• prolonged exposure to radiation.

Classification depending on the area in which the inflammatory process is localized:

• central serous chorioretinitis. In this case, the inflammation affects the macular area of ​​the eye;
• equatorial. Inflammation is localized near the equator of the eye;
• peripapillary. The process is localized in close proximity to the optic nerve;
• peripheral. Inflammation occurs along the dentate line.

Depending on the number of inflammatory foci:

• focal chorioretinitis. There is one focus of inflammation;
• multifocal disseminated. Inflammation is observed immediately in several parts of the eye;
• diffuse. A lot of inflammatory foci are formed, which tend to merge.

Depending on the nature of the course of the pathological process:

• spicy;
• chronic.

Chorioretinitis

At the initial stages of the progression of chorioretinitis, blurred vision is observed, and after a few days a dark spot appears in the field of vision. Also, a change in color perception is not ruled out. Further, the clinical picture is supplemented by the following symptoms:

• "flies" before the eyes;
• chicken blindness. This symptom is characterized by a decrease in visual acuity at dusk;
• photosensitivity is significantly increased;
• vision distortion. In medicine, this condition is called metamorphopsia;
• periodically before the eyes there are "flashes";
• clouding of the retina;
• pain in the eyes.

Toxoplasmic chorioretinitis in most clinical situations is congenital. Infection occurs during the intrauterine development of the fetus. Infectious agents affect not only parts of the eye, but also the tissues of the central nervous system, vital organs. The pathological process is undulating - periods of exacerbation alternate with periods of remission. This condition is very dangerous, because without proper treatment, detachment of the retina can occur.

Tuberculous type progresses only against the background of the primary lesion of the lungs. Specific tubercles are formed on the fundus of the eye. After treatment, scars remain on the surface.

Syphilitic chorioretinitis manifests itself quite specifically. On the fundus there is an alternation of pathological areas. There are areas with fibrosis, but there are also areas with pigmentation.

If the patient shows these symptoms, you should go to a medical facility for a comprehensive diagnosis. The standard examination plan includes the following methods:

• assessment of visual acuity;
• perimetry;
• refractometry;
• biomicroscopy;
• ophthalmoscopy using a special Goldman lens;
• fluorescein angiography;
• electroretinography.

The cause of the progression of chorioretinitis can be identified using the following diagnostic methods:

• general blood analysis;
• blood biochemistry;
• Analysis of urine;
• tests for the presence of antibodies to infectious diseases (hepatitis, syphilis, etc.).

Chorioretinitis is treated by an ophthalmologist. It is best to place the patient in a hospital for the duration of treatment, so that specialists have the opportunity to constantly monitor his condition. The treatment plan includes:

• the use of anti-inflammatory drugs;
• parabulbar and retrobulbar injections;
• etiotropic treatment. Its main goal is to eliminate the cause of the pathology. For this, the patient is prescribed antiviral, antibacterial drugs;
• detoxification therapy;
• immunotherapy;
• desensitizing therapy;
• physiotherapy treatment.

In severe cases, doctors resort to laser coagulation of the retina. This modern method of treatment allows localizing the inflammatory process.

Table of contents [Show]

Among inflammatory diseases, chorioretinitis occupies a special place, since it can be considered as a combination of two pathologies: choroiditis and retinitis. The disease is quite rare and usually affects the capillaries of the organs of vision. This rarity is also due to the fact that chorioretinitis can act as a complication or symptom of other serious diseases. Therefore, it is important to detect and eliminate it in time.

Chorioretinitis as a combination of choroiditis and retinitis is a disease of the visual apparatus, accompanied by inflammatory processes in an acute chronic form. The anomaly affects the retina and the posterior part of the capillary membrane of the eye. In this case, blood circulation and blood supply is disturbed. First, the destructive process occurs on the retina, then it passes to the back wall of the eye.

Eye with chorioretinitis

You should not waste time until the disease has passed into the second stage of development, because then it will be more difficult to eliminate it.

The main forms of chorioretinitis are determined by the reason for its occurrence. This classification can be divided into:

• infectious(associated with fungal, bacterial or viral infection);
• allergic(caused by various types of allergies);
• adjacent(can be caused by several reasons);
• post-traumatic(occurs against the background of injuries and mechanical damage to tissues);
• Caused by systemic diseases of the body.

In addition, it is possible to distinguish the acquired and congenital type, as well as chronic and acute. With congenital, the occurrence of abnormal neoplasms and retinal detachment at a severe stage can be observed.

Retinal detachment in congenital chorioretinitis

The congenital form of the disease can very seriously affect the overall health of a person (future child). Therefore, women during pregnancy must carefully follow the regimen and recommendations of the doctor.

Depending on the area of ​​the inflammatory process, the following classification is allowed:

• Central serous chorioretinitis (affects the macular area);
• Equatorial (determined at the equator of the eyeball);
• Peripheral (localized near the dentate line of the eye);
• Peripapillary (determined near the optic nerve).

Central serous chorioretinitis

According to the number of foci:

• Focal- the only area of ​​​​inflammation;
• diffuse- a lot of connecting inflammations;
• Multifocal- several foci.

Often the prerequisites for the occurrence of chorioretinitis are serious diseases of the body. Among the main reasons are especially distinguished:

• Infections of various degrees of complexity (including tuberculosis, HIV, syphilis);
• autoimmune diseases;
• Exposure to a high proportion of radiation;
• Myopia (complications and severe forms);
• Traumatic injuries of varying severity and infection due to their occurrence;
• toxic infection;
• hypothermia;
• Immune deficiency.

Myopia as a cause of chorioretinitis

If one of these factors is present, it is necessary to register with an ophthalmologist and periodically undergo a medical examination.

Symptoms of the disease often depend on the degree of its development. So, at the initial stage, optical effects, fogging, impaired color perception are often observed. In addition, it is likely:

• Night blindness (deterioration of the quality of vision at dusk and at night);
• Increasing the sensitivity of light;
• "flashes", "lightning", "flies" before the eyes;
• Image distortion;
• Cutting and pain.

This is how "flies" appear before the eyes

Infectious pathologies affect the central nervous system and act in waves, alternating with stages of remission. The tuberculous form of the disease primarily affects the lungs and forms tubercles in the fundus. Syphilis forms fibrous and pigmented areas on the surface of the eye.

These symptoms may be signs of other serious diseases. Therefore, the final diagnosis can only be made by a qualified ophthalmologist.

It is necessary to treat chorioretinitis in a timely manner. In the absence of proper therapy, retinal detachment, the formation of fibrous and abnormal tissues, and loss of vision are possible. It is also likely that thrombi of the eye capillaries and retinal veins and various hemorrhages in the tissue at any level.

Thrombosis of the central retinal vein as a complication of chorioretinitis

The study and diagnosis of the disease has several stages. It is thanks to her that one can determine the type and degree of development of chorioretinitis and choose the right treatment.. The medical examination includes:

• Measurement of visual acuity;
• Refractometry;
• Perimetry;
• Biomicroscopy (to determine the condition of tissues);
• Ophthalmoscopy with dilated pupil;
• Ultrasound to detect the presence of opacities;
• Electroretinography and other studies.

Determination of visual acuity

It may be important in this case to conduct examinations from specialists in other areas (to determine the cause), obtain a blood and urine test and the results of the Mantoux reaction.

Since the disease is complex, it almost always requires a systematic approach. It is almost impossible to make a diagnosis without the conclusion of specialists from other areas.

Chorioretinitis therapy is usually prescribed based on the definition of the form of the disease and its causes. As a rule, it has an individual composition.

Drug treatment is often the leading one and is prescribed in most cases. Among the main sets of medicines:

• Anti-inflammatory (including hormonal): Diclofenac, Indomethacin, Diprospan;
• Maintaining and increasing the level of immunity: Fluorouracil, Levamisole;
• Against intoxication: Hemodez (intravenously).

Diclofenac

Vitamins and a therapeutic diet are also often used.

Traditional medicine recipes can be used as an additional remedy for the treatment of chorioretinitis. Among the safest and most effective:

• Valerian root. Pour ten grams of the product with a glass of boiling water, boil for half an hour, then leave for another thirty minutes. Take a teaspoon three to four times a day.
• Hazel bark. Pour ten grams of the product with boiling water in the amount of two hundred milliliters and insist for two hours. Take three to four times a day for a teaspoon.
• Hawthorn. Pour twenty grams of berries with a glass of boiling water and insist until completely cooled. Take a teaspoon one hour before meals or one hour after it.

As a radical means to combat chorioretinitis, a laser device is used. The operation is carried out within half an hour (or more) and gives a quick positive effect. Before laser coagulation, preparation of the patient is required, after - carrying out measures to restore the rehabilitation period.

laser coagulation procedure

Positive results are also obtained by the use of physiotherapy and, in particular, electrophoresis. The process of inflammation slows down and consequently retinal detachment and other complications are prevented.

The choice of the method of therapy always lies with the attending physician. Before using other drugs (including folk remedies), you should consult an ophthalmologist and therapist.

The main preventive measure that prevents the appearance of a congenital form of chorioretinitis is the observance of the regimen of pregnant women and the avoidance of traumatic situations and stress. In other cases, it is effective to follow the following rules:

• Timely treatment of all diseases of the body, especially infectious ones;
• Compliance with basic hygiene standards;
• Support for a healthy level of immunity;
• Timely correction of vision (with the help of exercises, glasses and lenses, surgical operations);
• Passing preventive examinations at the ophthalmologist and therapist;
• Identification and relief of allergies.

Compliance with all the rules of prevention cannot guarantee that the disease will not occur. However, it can several times reduce the risk of chorioretinitis.

Chorioretinitis is a complex disease of the visual apparatus that can affect the retina and the main capillaries of the organs of vision, thereby leading to various diseases of the retina. In the case when it is caused by other dangerous diseases, the pathology can be complicated and cause retinal detachment and loss of vision. In order to prevent this, it is necessary to take preventive measures, eliminate diseases of the body in a timely manner and visit an ophthalmologist at least once a year.

Chorioretinitis is an inflammatory process that affects the posterior sections of the vascular membranes of the eyeballs. The disease also spreads to the retina. This leads to a decrease in the rate of blood circulation processes. This fact is explained by the fact that a large number of infectious agents linger in the back of the eyeballs.

Chorioretinitis of the eye spreads gradually, initially affecting the capillary network that feeds the retina with blood, and then spreading directly to the network of large vessels. Inflammation can be either acute or chronic. The presented ailment is classified according to a number of signs, where each of the types has its own signs and causes.

Pathology can manifest itself at any age. Chorioretinitis in a child appears as a result of the development of an infectious disease, and in adults due to improper use of optical correctors or with constant contact with chemical reagents.

Chorioretinitis is classified according to several criteria that determine the form and type of development of the disease. Among them are:

• distribution area;
• the number of foci;
• duration of manifestation;
• pathogens.

The disease can manifest itself in different parts of the eyes. On this basis, it is divided into:

• Central serous chorioretinitis (develops in the macular region of the eye).
• Peripapillary (spread near the optic disc). It stands out juxtapapillary chorioretinitis, which can occur in a child in the form of an oval-shaped focus of exudate near the optic nerve head. It affects the vasculature of the retina and the vitreous body.
• Equatorial (inflamed retinochoroiditis (actual choroid), located near the equatorial part of the eye).
• Peripheral (appears at the border of the dentate line).

Localization can be observed in one or more areas on the eyeball. It is divided on this basis into:

• Focal chorioretinitis is characterized by a concentration of inflammation in only one area;
• Multifocal is an inflammation that is localized in several areas of the eye;
• Diffuse is represented by a large number of foci of inflammation, while their merging is possible.

Pathology has two types of manifestation, which differ in duration:

• Acute - there is a manifestation of the disease up to one trimester.
• Chronic - manifests itself longer in time, unlike the acute form, and at least three months.

Due to the development, chorioretinitis is divided into:

• Infectious;
• Non-infectious-allergic;
• post-traumatic;
• Infectious-allergic.

Toxoplasmosis chorioretinitis is a congenital disease. Infection occurs in utero with maternal toxoplasmosis. Not only the eyes are affected, but also the central nervous system with other organs. The course is chronic in nature. The foci are represented by pronounced contours with the manifestation of rough pigmentation.

At a high rate of progression is characterized by:

• marginal infiltrations;
• prominence of new foci into the vitreous body;
• retinal detachment;
• the formation of a neovascular membrane;
• retinal hemorrhages.

tuberculous chorioretinitis is secondary in nature and can develop only when infected with pulmonary tuberculosis. Manifested by the occurrence of disseminated tubercles. When the treatment is carried out, chorioretinal scars remain.

Syphilitic- extends to the fundus and is characterized by alternating pigmentation foci with fibrous foci of atrophy.

Purulent is the result of immunodeficiency. This variety is dangerous by the spread of exudate to other sectors of the eyes. An immunodeficient species is distinguished in it, which is expressed by a large area of ​​the lesion, hemorrhagic and necrotic in nature. Treatment of this type is very difficult, and a complication can turn into complete blindness for the patient.

The rest of the species have practically no distinctive features. However, myopic chorioretinitis can be distinguished in them. It develops in the region of the yellow spot, which is located on the surface of the retina. This happens due to recurrent retinal hemorrhages and retinochoroiditis of the eyes with a high degree of myopia.

The initial is characterized by:

• the appearance of grayish-yellowish foci with weak outlines,
• the formation of exudate localized along the vascular network;
• occurrence of hemorrhages.

With a developed disorder, there are:

• foci with strongly pronounced outlines;
• their pigmentation;
• atrophy of the retina and vascular surface in the affected area;

Basically, chorioretinitis is manifested due to:

• infectious diseases (toxoplasmosis, syphilis, herpes virus);
• autoimmune pathologies (diabetes mellitus, arthritis, etc.);
• immunodeficiency diseases (HIV infections);
• toxins (with prolonged development of hemophthalmia, chorioretinitis occurs, because the products of the destruction of blood elements are toxic);
• viruses (influenza virus);
• receiving damage;
• the development of allergies;
• prolonged exposure to the radiation field;
• development of complications associated with myopia.

It manifests itself in the place where the focus of occurrence is localized. It can be diagnosed by the following signs:

• blurred field of vision;
• the sharpness of the visual apparatus worsens;
• dark areas appear;
• flashes (photopsy) are observed;
• sparks flash in the visual review;
• the outlines and sizes of the objects under consideration are distorted (micropsy, macropsy, metamorphopsia);
• difficult orientation at dusk (night blindness);
• increased sensitivity to bright light sources;
• cloudy retina;
• pain in the eye area is fixed;
• possible change in color perception.

Each of these signs indicates the development of an eye disease, therefore, at the first detection of them, you need to visit a doctor without delay and conduct a diagnosis. It is also necessary to take into account the fact that some types can pass without showing symptoms, such as peripheral varieties.

To confirm the diagnosis is carried out:

• checking visual acuity, which worsens with a lesion of the central type, while it cannot be corrected;
• perimetry, as scotomas, dark spots may appear and a sharp decrease in the sensitivity of the retina is observed;
• refractometry (does not change);
• biomicroscopy (helps to identify whether there was a deformation of the vitreous body or not);
• examination of the eyes in transmitted light (clouding of the vitreous body is detected);
• ophthalmoscopy (determine the type and stage of development of the disease).
• fluorescein angiography, which allows to detect changes in the vessels of the fundus (the occurrence of microaneurysms, shunts);
• electroretinography, which allows you to clarify the condition of the retina and how well it functions;
• optical coherence tomography of the retina, which determines the morphological features of the focus of inflammation;
• Ultrasound (with the help of this procedure, the doctor detects the state of optical media).

Biomicroscopy

Doctors

If necessary, seek advice from:

• therapist
• pediatrician (if chorioretinitis is found in a child);
• infectious disease specialist;
• immunologist;
• venereologist;
• allergist;
• phthisiatrician;
• ENT;
• dentist.

So can this disease be cured? Yes, but it is important to understand that treatment for chorioretinitis should be timely and individual. Local therapy in this case is extremely ineffective. An exception is the use of parabulbar and retinobulbar injections.

In conservative treatment, various groups of drugs are used:

This group of drugs allows you to eliminate the provoking factor:

When bacterial species, antibiotics are used. They help to identify the causative agent of the disease.

Manifestations viral types are cured:

• interferons;
• inducers of interferonogenesis (Amiksin, Neovir);
• antiviral drugs (oseltamivir, zanamivir).

syphilitic the variety is treated with antibiotics that belong to the penicillin group. With their intolerance, a course is prescribed:

• doxycycline;
• macrolides (Erythromycin, Spiramycin, etc.);
• cephalosporins (cefazolin, cephalexin).

Important! The dosage is determined only by the doctor.

In inflammatory processes caused by toxoplasma are assigned:

• sulfadimezin;
• pyrimethamine (in addition to it, folic acid and vitamin B12 are taken).

tuberculous chorioretinitis is treated with the use of drugs and sessions with a phthisiatrician. In the chronic form, a course is prescribed:

• isoniazid;
• rifampicin;
• streptomycin;
• kanamycin;
• hormonal medications.

Group of anti-inflammatory drugs:

• indomethacin;
• diclofenac;
• hydrocortisone;
• dexamethasone.

These drugs are taken orally, that is, their action is activated in the gastrointestinal tract. For local, intravenous or intramuscular injection, diprospan is prescribed. The dosage is determined by the attending physician.

It includes gemodez and 5% glucose solution, which are taken intravenously.

The intake of these drugs directly depends on how pronounced the inflammatory process is. For example, in the active form, immunosuppressants (mercaptopurine, fluorouracil) or immunostimulants (levamisole for HIV-infected patients) are used.

Thanks to them, it is possible to conduct hyposensitizing therapy. For this are used:

• suprastin;
• claritin;
• erius.

Appointed to improve the resistance of pathology:

• vitamin C;
• group B;
• multivitamin complex.

Enzymes are prescribed to increase the rate of elimination of inflammatory processes.

In the retrobulbar way, it is accepted:

• hemase;
• fibrinolysin;
• histochrome;
• lidase.

If the pathology manifests itself for a rather long period, then extracorporeal detoxification methods are used for treatment:

• hemosorption;
• plasmapheresis.

Physiotherapy is used to speed up the healing process. An excellent effect among physiotherapeutic procedures is electrophoresis with the combined use of lidase, fibrinolysin.

Surgical intervention is relevant for:

• the spread of inflammatory processes;
• occurrence of complications.

To slow down the process of inflammation, laser coagulation of the retina is performed. This is done in order to limit the chorioretinal foci from unaffected tissues.

If a chorioretinal membrane has formed or a retinal detachment has occurred, then a vitrectomy is performed.

The disease under consideration, with inadequate treatment, as well as when it is started, can result in serious complications for the patient:

• retinal disinsertion;
• formation of a neovascular membrane;
• the occurrence of recurrent retinal hemorrhages;
• thrombosis of the venous network of the retina and others, leading to one hundred percent blindness.

To avoid conditions for the occurrence of chorioretinitis, it is necessary to follow certain preventive tips:

• at the first symptoms of any disease, contact a specialist;
• periodically visit an ophthalmologist to check the state of eye health (a child can visit an ophthalmologist already in the first three months from the date of birth);
• do not get into situations that could result in serious injury;
• observe eye hygiene;
• sanitize foci of infection in the mouth and sinuses.

Central chorioretinitis, tuberculous or any other, is a rather difficult disease to cure. It has a large number of varieties and treatment will depend on the manifestation of one form or another. This disease affects at any age: adults get sick for various reasons, and children tend to get sick when the infection develops.

With the progression of the pathology without proper treatment, various complications can develop, and the patient is subsequently assigned a disability.

The collective name for a whole group of diseases associated with inflammatory processes affecting the choroid of the eye is the concept of uveitis. Chorioretinitis of the eye is one of the forms of such a pathology. In this regard, the disease received a different name - posterior uveitis, since it affects this particular part of the eye. If there is no proper treatment or it is started late, then the inflammation becomes chronic. There is a malnutrition of the eye, as the choriocapillary vessels are inflamed, supplying it with useful substances. This leads to complications that threaten the patient's vision. Chorioretinitis, what it is and why it manifests itself, should be considered in more detail.

Inflamed vessels with chorioretinitis are not able to fully nourish the organ of vision. This is due to some structural features of the eye. Since in this area the blood vessels are located on a wide bed, the movement of blood slows down. In this case, there are many branches. Stagnation in the circulatory system allows the pathogenic microorganisms that have entered it to develop intensively. Infectious agents in large quantities linger in the posterior part of the eyeballs. The rapid multiplication of microorganisms leads to the further development of inflammation.

The spread of posterior uveitis occurs gradually. First, chorioretinitis affects the capillary network that supplies blood to the retina. Then it affects the larger vessels.

The causes of the development of an inflammatory process that affects the choroid (called choroiditis), which is also accompanied by inflammation of the retina (retinitis), may be:

Common causes of chorioretinitis are infection of the body with a number of viruses.

Injuries to the organ of vision, as well as conditions leading to weakened immunity, lead to the disease. This factor is manifested due to prolonged treatment, as well as with HIV infection.

Most often, the penetration of the pathogen into the eye vessels occurs through the bloodstream. In this case, they say that chorioretinitis has an acquired character. But the disease can manifest itself in a congenital form. This occurs during intrauterine infection.

In young children, toxoplasmosis chorioretinitis is more often detected. At the same time, clinical manifestations of the disease very rarely occur immediately after birth. Often, a congenital disease is diagnosed only by the age of seven, when the child undergoes a medical examination for school.

An autoimmune disease is considered to be a rather rare form of posterior uveitis - Birdshot chorioretinopathy. The process of inflammation of the vascular membrane, as well as the retina, develops in this pathology in a progressive form. In this case, it often shows resistance to treatment.

Such an inflammatory process can occur in acute or chronic form. Chorioretinitis is also classified according to several main features that determine both the form and type of the disease. These characteristics should be considered separately.

Chorioretinitis is classified according to the form of the course, the area of ​​\u200b\u200bdistribution, the number of foci, stages and pathogens.

Distribution area

Pathology can occur in different parts of the organ of vision. On this basis, the disease is divided as follows:

1. If the macular region is affected (refers to the yellow spot), then the disease is called central serous chorioretinitis of the eye.
2. With the spread of pathology in the vicinity of the optic disc - peripapillary lesions. In the event of an oval-shaped exudate focus in the same area, the disease is considered as juxta-papillary chorioretinitis. In this case, the vessels of the retina are damaged, and the vitreous body is also affected.
3. Equatorial. This type of pathology is characterized by inflammation of the choroid, located near the equatorial region of the eye.
4. Peripheral. With this development of inflammation, the area along the border of the dentate line is affected.

The process of inflammation can be localized in only one place. However, its development is sometimes observed in several areas of the eyeball at once. By the number of foci, the disease is classified:

1. Focal view. The inflammatory process is concentrated in one place.
2. Multifocal. Several areas of the eye are affected at once.
3. Diffuse type of pathology. This development of inflammation leads to many lesions. In some cases, they merge together.

With focal chorioretinitis, the inflammatory process is concentrated in one place.

Duration of manifestation

According to this criterion, the disease manifests itself in two forms with different durations:

1. Acute chorioretinitis. The disease lasts up to ten days.
2. Chronic form. The disease can last much longer than three months.

The etiology of the disease is also of great importance for classification. Depending on this feature, there are:

• the infectious nature of the infection;
• allergic manifestation, the causes of manifestation are not associated with infection;
• post-traumatic - the disease developed as a result of an injury;
• infectious-allergic type of lesion.

Infectious chorioretinitis is divided into subspecies depending on the pathogen.

An infectious type of pathology is manifested more often than other categories. There are four varieties of it.

1. The toxoplasmic species is the congenital type. Infection of the child occurs in the process of intrauterine development of the fetus. The cause is toxoplasmosis in the mother. This is a chronic disease. The lesion is clearly separated by a contour.
2. Tuberculous type of pathology is a disease secondary to the onset. It develops only in case of manifestation of pulmonary tuberculosis. After the therapy, a chorioretinal scar remains as a reminder of the disease. It can dissolve over time in some cases.
3. Syphilitic chorioretinitis. Place of distribution - the fundus of the eye. At the same time, two types of foci are clearly distinguished in their alternation: fibrous and pigmented. Such alternations allow you to confidently determine the syphilitic lesion.
4. Purulent. AIDS is the "culprit" of this type of manifestation. With this type of disease, purulent discharge spreads to other sectors of the eye. In this variety, an immunodeficient species is isolated separately, in which a large area is affected.

It should be noted that other species have almost no special distinguishing features. However, it is worth highlighting myopic chorioretinitis separately. It manifests itself with severe myopia due to frequently recurring hemorrhages in the membrane and retina of the organ of vision. With this disease, the condition of proper lighting should be clearly met if it is necessary to perform work at close range.

Toxoplasmic chorioretinitis is congenital. The baby gets infected from the mother.

stages

The characteristic features of the initial stage are:

• the appearance of faint outlines of foci of a yellowish hue;
• purulent discharges form along the network of vessels;
• small hemorrhages occur.

In the future, with the development of inflammation, it is possible to observe:

• the formation of outlines of foci;
• the appearance of pigmentation;
• at the site of the lesion, atrophy of both the retina and the vascular surface occurs.

Atrophy of the retina and vascular surface indicates the last stage of the disease.

Symptoms

Inflammation occurring in the network of blood vessels does not show any significant symptoms. Unpleasant sensations occur only after the infection affects the retina. When the lesion is located in the center of the fundus, there are complaints of significantly reduced vision, as well as distortion of objects. Characterized by the appearance of bright flashes before the eyes. A few days after the retina has been affected, a dark spot appears in the field of vision. This manifestation does not depend on which eye was affected - the right or left.

The acute form of the pathology is accompanied by the following symptoms:

• there is an increased sensitivity to light;
• “flies” float before the eyes;
• in the dark, visual acuity is significantly reduced, “night blindness” appears;
• in the eye area there is a pulling pain;
• tears often flow spontaneously.

If vision deteriorated significantly in the dark, this is a symptom of peripheral inflammation. With the manifestation of several symptoms, the likelihood of detecting a diffuse type of pathology increases. In the case of purulent chorioretinitis, severe symptoms appear.

Only a doctor can make a diagnosis - chorioretinitis, having the results of diagnostic tests in his hands.

It is impossible to independently diagnose such a disease. The naked eye is unable to recognize chorioretinitis. This requires special tools and devices.

To make a diagnosis, the following steps are taken:

1. Checking visual acuity. With this pathology, the patient always begins to see worse.
2. Computed perimetry is performed. This test allows you to determine if there are dark spots and how sensitive the fiber is.
3. Biomicroscopy is performed. The procedure is necessary to detect changes in the vitreous body.
4. In transmitted light, the presence of turbidity is detected.
5. Ophthalmoscopy is performed to detect deep lesions. The border of the lesion is determined, and pigmentation is also detected.
6. Vascular changes can be determined by angiography.
7. Diagnosis of the state of the retina is performed using electroretinography.

Diagnostic measures also include the performance of procedures such as optical tomography and ultrasound. The patient will be given a referral for urine, blood and Mantoux test. Fluorography is also needed to check the condition of the lungs.

Often, the cause of chorioretinitis, as well as the symptoms that appear, and the appropriate treatment is prescribed. Therapy of chorioretinitis is performed purely individually. Local procedures and injections are needed. Among the medicines, etiotropic agents should be noted. Their focus should be on the main cause of the pathology. To identify the pathogen, a broad-spectrum antibiotic is prescribed.

Therapy of chorioretinitis is aimed primarily at treating the cause of the pathology.

Viral infections require antiviral drugs. For syphilis, antibiotics from the penicillin group are used. Most often, treatment lasts a month. Sulfadimezin and Folic acid are used.

Treatment is carried out using anti-inflammatory drops (Broxinac), as well as hormonal agents (Maxidex) both intramuscularly or intravenously, and by ingestion. In case of detection of toxins (in case of poisoning), detoxification and the use of antiallergic drugs (Claritin) are necessary. Pregnancy is a contraindication for the use of most drugs. In this state, Diprospan is used to relieve inflammation.

Often, drugs that strengthen the immune system (Cycloferon) are required. To increase the body's resistance, vitamins C, B are prescribed.

It should be remembered that with an immunodeficient type of pathology, bad complications are possible, and the consequences and prognosis for the patient are unfavorable. There may be total blindness.

In the absence of positive results, surgical intervention may be used. In recent years, lasers have been increasingly used for this. The duration of the operation does not exceed twenty minutes.

There is no universal folk way to cure such a pathology. In addition, such treatment can lead to irreversible consequences. However, to help traditional therapy, it is possible, in agreement with the attending physician, to use freshly squeezed carrot juice, infusion of hawthorn or valerian, decoction of hazel bark and tincture of echinacea.

In the case of a diagnosis of "horiretinitis", the question of whether the disease can be cured arises in the patient in the first place. With timely therapy, the prognosis is favorable. It is this approach that is the basis of prevention. In addition, it is necessary to regularly be examined by an ophthalmologist.

It should not be forgotten that a frivolous attitude to the therapy of the patient himself can lead him to blindness.

Nov 28, 2017Anastasia Tabalina

Central serous chorioretinitis is a polyetiological disease that is provoked by allergic, infectious, vascular and toxic factors. The pathogenetic path of development of chorioretinitis is due to the formation of defects in the basal plate, as well as vasomotor disorders. This leads to a pathological increase in the permeability of the capillary bed and vascular membranes, as well as some areas of the basal lamina.

Symptoms

Central serous chorioretinitis in the early stages usually presents with blurred vision. In the future, the formation of a dark spot occurs. Quite often, metamorphopsia and photopsia join. There may also be a decrease in visual acuity, the severity of which ranges from tenths to hundredths. Some patients develop central scotoma, transient hypermetropia, and impaired color vision.

Diagnosis and stages of the disease

During ophthalmoscopy in the early stages of the disease, retinal opacity in the macula area can be detected. Opacification has a round or oval shape, and the diameter ranges from 0.5 to 2 diameters of the optic nerve head. The pathological focus usually protrudes slightly forward, and at the border of its vessels make a slight bend. Also, a light reflex can be detected along the border. The severity of macula opacity varies from subtle to pronounced gray. In some cases, not a foveal, but an eccentric paramacular location is detected.

After some time (from several days to several months), central serous chorioretinitis passes to the second stage. It is also called the stage of precipitates. At the same time, there is an increase in visual acuity, but there is still a spot in front of the eye. With ophthalmoscopy, it is possible to reveal only gray-white small-dotted foci, called precipitates, and the area of ​​opacification is practically resolved.

In the third stage of the disease, central scotoma and metamorphopsia no longer bother the patient. Visual acuity usually returns to baseline. Ophthalmoscopy often fails to detect precipitates and edema, but an area of ​​dyspigmentation is usually present. The macula becomes mottled in color, which is associated with the presence of small clumps of pigment, small areas of discoloration of the pigment epithelium, as well as yellow flat lesions.

Central serous chorioretinitis can affect one or both eyes. This process is prone to recurrence, so the prognosis is usually unfavorable. Due to the absence of vivid symptoms, it is rather difficult to diagnose pathology during an outpatient examination. To do this, it is necessary to conduct a comprehensive examination, which includes ophthalmochromoscopy, biomicroscopy, and fluorescein angiography. These techniques help to detect additional manifestations of chorioretinitis, which is important for differential diagnosis with other pathologies (retrobulbar neuritis, juvenile spot dystrophy).

Among the characteristic signs of central serous chorioretinitis, there is an expansion of the optical section of the retina, which is accompanied by the accumulation of transudate between the retina and the pigment epithelium, microprecipitates. Fluorescein angiography can also detect small defects in the basal lamina that look like dye leak points (fluorescent flags).

Treatment

In this disease, complex treatment is usually prescribed, which should take into account the etiology of chorioretinitis. Pathogenetic methods include laser coagulation of defects in the basal lamina. Approximately 4-10 days after the operation, signs of retinal edema disappear. In this case, you should additionally use drugs that restore vascular permeability (aevit, ascorutin), dehydration drugs (sodium chloride 10%, glucose solution 40%, glycerin, phonurite), vasodilator drugs (nicotinamide, no-shpa). Cocarboxylase, vitamins, heparin and ATP can be used to improve metabolism in retinal cells. With symptoms of edema of the retinal substance, glucocorticosteroids are prescribed (for retrobulbar administration).

Chorioretinitis is an inflammatory process that affects the posterior sections of the vascular membranes of the eyeballs. The disease also spreads to the retina. This leads to a decrease in the rate of blood circulation processes. This fact is explained by the fact that a large number of infectious agents linger in the back of the eyeballs.

Chorioretinitis of the eye spreads gradually, initially affecting the capillary network that feeds the retina with blood, and then spreading directly to the network of large vessels. Inflammation can be either acute or chronic. The presented ailment is classified according to a number of signs, where each of the types has its own signs and causes.

Note! "Before you start reading the article, find out how Albina Gurieva was able to overcome vision problems using ...

Pathology can manifest itself at any age. Chorioretinitis in a child appears as a result of the development of an infectious disease, and in adults due to improper use of optical correctors or with constant contact with chemical reagents.

Chorioretinitis is classified according to several criteria that determine the form and type of development of the disease. Among them are:

• distribution area;
• the number of foci;
• duration of manifestation;
• pathogens.

Distribution area

The disease can manifest itself in different parts of the eyes. On this basis, it is divided into:

• Central serous chorioretinitis (develops in the macular region of the eye).
• Peripapillary (spread near the optic disc). It stands out juxtapapillary chorioretinitis, which can occur in a child in the form of an oval-shaped focus of exudate near the optic nerve head. It affects the vasculature of the retina and the vitreous body.
• Equatorial (inflamed retinochoroiditis (actual choroid), located near the equatorial part of the eye).
• Peripheral (appears at the border of the dentate line).

Number of foci

Localization can be observed in one or more areas on the eyeball. It is divided on this basis into:

• Focal chorioretinitis is characterized by a concentration of inflammation in only one area;
• Multifocal is an inflammation that is localized in several areas of the eye;
• Diffuse is represented by a large number of foci of inflammation, while their merging is possible.

Duration of manifestation

Pathology has two types of manifestation, which differ in duration:

• Acute - there is a manifestation of the disease up to one trimester.
• Chronic - manifests itself longer in time, unlike the acute form, and at least three months.

causative agents of pathology

Due to the development, chorioretinitis is divided into:

• Infectious;
• Non-infectious-allergic;
• post-traumatic;
• Infectious-allergic.

Toxoplasmosis chorioretinitis is a congenital disease. Infection occurs in utero with maternal toxoplasmosis. Not only the eyes are affected, but also the central nervous system with other organs. The course is chronic in nature. The foci are represented by pronounced contours with the manifestation of rough pigmentation.

At a high rate of progression is characterized by:

• marginal infiltrations;
• prominence of new foci into the vitreous body;
• retinal detachment;
• the formation of a neovascular membrane;
• retinal hemorrhages.

tuberculous chorioretinitis is secondary in nature and can develop only when infected with pulmonary tuberculosis. Manifested by the occurrence of disseminated tubercles. When the treatment is carried out, chorioretinal scars remain.

Syphilitic- extends to the fundus and is characterized by alternating pigmentation foci with fibrous foci of atrophy.

Purulent is the result of immunodeficiency. This variety is dangerous by the spread of exudate to other sectors of the eyes. An immunodeficient species is distinguished in it, which is expressed by a large area of ​​the lesion, hemorrhagic and necrotic in nature. Treatment of this type is very difficult, and a complication can turn into complete blindness for the patient.

The rest of the species have practically no distinctive features. However, myopic chorioretinitis can be distinguished in them. It develops in the region of the yellow spot, which is located on the surface of the retina. This happens due to recurring retinal hemorrhages and retinochoroiditis of the eyes with.

stages

The initial is characterized by:

• the appearance of grayish-yellowish foci with weak outlines,
• the formation of exudate localized along the vascular network;
• occurrence of hemorrhages.

With a developed disorder, there are:

• foci with strongly pronounced outlines;
• their pigmentation;
• atrophy of the retina and vascular surface in the affected area;

Causes

Basically, chorioretinitis is manifested due to:

• infectious diseases (toxoplasmosis, syphilis, herpes virus);
• autoimmune pathologies (diabetes mellitus, arthritis, etc.);
• immunodeficiency diseases (HIV infections);
• toxins (with prolonged development of hemophthalmia, chorioretinitis occurs, because the products of the destruction of blood elements are toxic);
• viruses (influenza virus);
• receiving damage;
• the development of allergies;
• prolonged exposure to the radiation field;
• the development of complications associated with.

Symptoms

It manifests itself in the place where the focus of occurrence is localized. It can be diagnosed by the following signs:

• blurred field of vision;
• the sharpness of the visual apparatus worsens;
• dark areas appear;
• flashes (photopsy) are observed;
• sparks flash in the visual review;
• the outlines and sizes of the objects under consideration are distorted (micropsy, macropsy, metamorphopsia);
• difficult orientation at dusk (night blindness);
• increased sensitivity to bright light sources;
• cloudy retina;
• pain in the eye area is fixed;
• possible change in color perception.

Each of these signs indicates the development of an eye disease, therefore, at the first detection of them, you need to visit a doctor without delay and conduct a diagnosis. It is also necessary to take into account the fact that some types can pass without showing symptoms, such as peripheral varieties.

Diagnostics

To confirm the diagnosis is carried out:

• check, which worsens with a lesion of the central type, while it cannot be corrected;
• perimetry, as scotomas, dark spots may appear and a sharp decrease in the sensitivity of the retina is observed;
• refractometry (does not change);
• biomicroscopy (helps to identify whether there was a deformation of the vitreous body or not);
• examination of the eyes in transmitted light (clouding of the vitreous body is detected);
• ophthalmoscopy (determine the type and stage of development of the disease).
• fluorescein angiography, which allows to detect changes in the vessels of the fundus (the occurrence of microaneurysms, shunts);
• electroretinography, which allows you to clarify the condition of the retina and how well it functions;
• optical coherence tomography of the retina, which determines the morphological features of the focus of inflammation;
• Ultrasound (with the help of this procedure, the doctor detects the state of optical media).

Doctors

If necessary, seek advice from:

• therapist
• pediatrician (if chorioretinitis is found in a child);
• infectious disease specialist;
• immunologist;
• venereologist;
• allergist;
• phthisiatrician;
• ENT;
• dentist.

Treatment

So can this disease be cured? Yes, but it is important to understand that treatment for chorioretinitis should be timely and individual. Local therapy in this case is extremely ineffective. An exception is the use of parabulbar and retinobulbar injections.

Medical

In conservative treatment, various groups of drugs are used:

Etiotropic

This group of drugs allows you to eliminate the provoking factor:

When bacterial species, antibiotics are used. They help to identify the causative agent of the disease.

Manifestations viral types are cured:

• interferons;
• inducers of interferonogenesis (Amiksin, Neovir);
• antiviral drugs (oseltamivir, zanamivir).

syphilitic the variety is treated with antibiotics that belong to the penicillin group. With their intolerance, a course is prescribed:

• doxycycline;
• macrolides (Erythromycin, Spiramycin, etc.);
• cephalosporins (cefazolin, cephalexin).

Important! The dosage is determined only by the doctor.

In inflammatory processes caused by toxoplasma are assigned:

• sulfadimezin;
• pyrimethamine (in addition to it, folic acid and vitamin B12 are taken).

tuberculous chorioretinitis is treated with the use of drugs and sessions with a phthisiatrician. In the chronic form, a course is prescribed:

• isoniazid;
• rifampicin;
• streptomycin;
• kanamycin;
• hormonal medications.

Anti-inflammatory

Group of anti-inflammatory drugs:

• indomethacin;
• diclofenac;
• hydrocortisone;
• dexamethasone.

These drugs are taken orally, that is, their action is activated in the gastrointestinal tract. For local, intravenous or intramuscular injection, diprospan is prescribed. The dosage is determined by the attending physician.

Detoxification

It includes gemodez and 5% glucose solution, which are taken intravenously.

Immunotherapeutic

The intake of these drugs directly depends on how pronounced the inflammatory process is. For example, in the active form, immunosuppressants (mercaptopurine, fluorouracil) or immunostimulants (levamisole for HIV-infected patients) are used.

Antihistamines

Thanks to them, it is possible to conduct hyposensitizing therapy. For this are used:

• suprastin;
• claritin;
• erius.

vitamins

Appointed to improve the resistance of pathology:

• vitamin C;
• group B;
• multivitamin complex.

Enzymatic

Enzymes are prescribed to increase the rate of elimination of inflammatory processes.

In the retrobulbar way, it is accepted:

• hemase;
• fibrinolysin;
• histochrome;
• lidase.

If the pathology manifests itself for a rather long period, then extracorporeal detoxification methods are used for treatment:

• hemosorption;
• plasmapheresis.

Physiotherapy

Physiotherapy is used to speed up the healing process. An excellent effect among physiotherapeutic procedures is electrophoresis with the combined use of lidase, fibrinolysin.

Surgical

Surgical intervention is relevant for:

• the spread of inflammatory processes;
• occurrence of complications.

To slow down the process of inflammation, laser coagulation of the retina is performed. This is done in order to limit the chorioretinal foci from unaffected tissues.

If a chorioretinal membrane has formed or a retinal detachment has occurred, then a vitrectomy is performed.

Complications

The disease under consideration, with inadequate treatment, as well as when it is started, can result in serious complications for the patient:

• retinal disinsertion;
• formation of a neovascular membrane;
• the occurrence of recurrent retinal hemorrhages;
• thrombosis of the venous network of the retina and others, leading to one hundred percent blindness.

Prevention

To avoid conditions for the occurrence of chorioretinitis, it is necessary to follow certain preventive tips:

• at the first symptoms of any disease, contact a specialist;
• periodically visit an ophthalmologist to check the state of eye health (a child can visit an ophthalmologist already in the first three months from the date of birth);
• do not get into situations that could result in serious injury;
• observe eye hygiene;
• sanitize foci of infection in the mouth and sinuses.

Central chorioretinitis, tuberculous or any other, is a rather difficult disease to cure. It has a large number of varieties and treatment will depend on the manifestation of one form or another. This disease affects at any age: adults get sick for various reasons, and children tend to get sick when the infection develops.

With the progression of the pathology without proper treatment, various complications can develop, and the patient is subsequently assigned a disability.