Viral Retinitis - Retinal Inflammatory Disease

Viral Retinitis

Definition

Retinal disorder caused by viral infection.

Epidemiology: 

Viral retinitis is a rare disorder

Pathogenesis: 

Infection of the retina and retinal vasculature caused bycytomegalovirus, herpes simplex, varicella-zoster, or rubella viruses. Viral retinitis frequently occurs in immunocompromised patients.

Symptoms: 

Patients report loss of visual acuity and visual field defects.

Diagnostic considerations: 

Slit-lamp examination will reveal cells in the vit-reous body. Ophthalmoscopic findings will include retinal necrosis with intraretinal bleeding (see Fig. 12.35). Necrosis can occur as acute lesions and spread over the entire retina like a grassfire within a few days. When the reti-nitis heals, it leaves behind wide-area scarring.

During pregnancy, rubella virus can cause embryopathy in the child. Oph-thalmic examination will reveal typical fine granular pigment epithelial scars on the fundus that are often associated with a congenital cataract. The diag-nosis is confirmed by measuring the serum virus titer. The possibility of com-promised immunocompetence should be verified or excluded.

Differential diagnosis: 

Posterior uveitis and vasculitis should be excluded.These disorders may be distinguished from viral retinitis by the absence of necrosis.

Treatment: 

The disorder is treated with high doses of an antiviral agent (acy-clovir, ganciclovir, or foscarnet) according to the specific pathogen.

Prophylaxis: 

Ophthalmologic screening examinations are indicated inimmunocompromised persons with suspected viral infection.

Clinical course and prognosis: 

Viral retinitis can be arrested if diagnosedearly. However, recurrences are frequent in immunocompromised patients. Blindness usually cannot be prevented in retinal necrosis syndrome.