Diagnosis and treatment of various forms of ocular chorioretinitis. Chorioretinitis, its types, symptoms and treatment methods

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Among the diseases inflammatory in nature chorioretinitis occupies a special place because 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 due, among other things, to the fact that chorioretinitis can act as a complication or symptom of other serious illnesses. 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 capillary membrane of the eye. In this case, blood circulation and blood supply are disrupted. At first destructive process occurs on the retina, then moves to the back wall of the eye.

Eye with chorioretinitis

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

The main forms of chorioretinitis are determined by the reason for its occurrence. According to this classification we can distinguish:

Infectious(associated with fungal, bacterial or viral infection);
Allergic(called various types allergies);
Adjacent(can be caused by several reasons);
Post-traumatic(occurs against the background of injuries and mechanical damage fabrics);
Caused by systemic diseases of the body.

In addition, one can distinguish acquired and congenital types, as well as chronic and acute. In congenital cases, the occurrence of abnormal neoplasms and retinal detachment at a severe stage may occur.

Retinal detachment due to congenital chorioretinitis

The congenital form of the disease can very seriously affect general condition human health (unborn child). Therefore, women during pregnancy must carefully follow the regimen and doctor’s recommendations.

Depending on the area 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 (detected near optic nerve).

Central serous chorioretinitis

By number of outbreaks:

Focal– the only area of inflammation;
Diffuse– many connecting inflammations;
Multifocal- several outbreaks.

Often the prerequisites for the occurrence of chorioretinitis are serious diseases of the body. The main reasons include:

Infections of varying degrees of complexity (including tuberculosis, HIV, syphilis);
Autoimmune diseases;
Exposure to high levels of radiation;
Myopia (complications and severe forms);
Traumatic injuries varying degrees severity and infectious contamination due to their occurrence;
Toxic contamination;
Hypothermia;
Immune deficiency.

Myopia as a cause of chorioretinitis

If one of the listed factors is present, it is necessary to register with an ophthalmologist and undergo periodic medical examinations.

The symptoms of the disease often depend on the degree of its development. Yes, on initial stage Optical effects, fogging, and disturbances in color perception are often observed. In addition, it is likely:

Night blindness (deterioration in the quality of vision at dusk and at night);
Increased light sensitivity;
“flashes”, “lightning”, “spots” before the eyes;
Image distortion;
Cutting and painful sensations.

This is how “floaters” 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.

The symptoms listed may be signs of other serious diseases. Therefore, only a qualified ophthalmologist can make a final diagnosis.

Chorioretinitis must be treated promptly. In the absence of proper therapy, retinal detachment, the formation of fibrous and abnormal tissues, and loss of vision are possible. The appearance of blood clots in the ocular capillaries and retinal veins and various hemorrhages in the tissue at any level are also likely.

Thrombosis of the central retinal vein as a complication of chorioretinitis

Research and diagnosis of the disease has several stages. It is thanks to it that you can determine the type and degree of development of chorioretinitis and choose correct treatment . Medical examination includes:

Visual acuity measurement;
Refractometry;
Perimetry;
Biomicroscopy (to determine the condition of tissues);
Ophthalmoscopy with a 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 with specialists in other fields (to determine the cause), obtain blood and urine tests and the results of the Mantoux reaction.

Since the disease is complex, it almost always requires systematic approach. Without the opinion of specialists in other fields, it is almost impossible to make a diagnosis.

Therapy for chorioretinitis is usually prescribed based on determining the form of the disease and its causes. As a rule, it has an individual composition.

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

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

Diclofenac

Vitamins and a therapeutic diet are also often used.

Recipes traditional medicine can be used as additional means for the treatment of chorioretinitis. Among the safest and most effective:

Valerian root. Pour ten grams of the product into 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 leave for two hours. Take a teaspoon three to four times a day.
Hawthorn. Pour twenty grams of berries with a glass of boiling water and leave until completely cool. Take a teaspoon one hour before meals or one hour after meals.

As radical remedy A laser device is used to combat chorioretinitis. The operation is carried out within half an hour (or more) and gives a quick positive effect. Before laser coagulation The patient needs to be prepared, followed by recovery measures during the rehabilitation period.

Laser coagulation procedure

The use of physiotherapy and, in particular, electrophoresis also gives positive results. The process of inflammation slows down and subsequently retinal detachment and other complications are prevented.

The choice of treatment method always lies with the attending physician. Before using others medicines(including folk remedies) you should consult an ophthalmologist and therapist.

The main preventive measure to prevent the appearance of the congenital form of chorioretinitis is adherence to the pregnant women’s regimen and avoidance of traumatic situations and stress. In other cases, following the following rules is effective:

Timely treatment of all diseases of the body, especially infectious ones;
Compliance with basic hygiene standards;
Support healthy immune levels;
Timely vision correction (with the help of exercises, glasses and lenses, surgical operations);
Walkthrough preventive examinations from an 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 reduce the risk of chorioretinitis several times.

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

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

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

Pathology can manifest itself at any age. Chorioretinitis in a child appears as a consequence of the development infectious disease, and in adults due to misuse 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:

area of distribution;
number of lesions;
duration of manifestation;
pathogens.

The disease can manifest itself in various parts of the eyes. By this characteristic it is divided into:

Central serous chorioretinitis (develops in the macular area of the eye).
Peripapillary (extends near the optic nerve head). It highlights juxtapapillary chorioretinitis, which can occur in a child in the form of an oval-shaped focus of exudate near the optic nerve head. Affects the retinal vasculature and vitreous.
Equatorial (retinochoroiditis (the choroid itself), located near the equatorial part of the eye, becomes inflamed).
Peripheral (appears at the border of the dentate line).

Localization can be observed in one or several areas on eyeball. It is divided according to this criterion into:

Focal chorioretinitis is characterized by the concentration of inflammation in only one area;
Multifocal is inflammation that is localized in several areas of the eye;
Diffuse presented a large number foci of inflammation, and their fusion is possible.

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

Acute – the manifestation of the disease is observed up to one trimester.
Chronic – manifests itself over a longer period of time, unlike acute form, and at least three months.

Due to its 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 and other organs. The nature of its course is chronic. The lesions are represented by pronounced contours with the appearance of coarse pigmentation.

At high speed progression is characterized by:

regional infiltration;
penetration of new lesions into the vitreous body;
retinal detachment;
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 appearance of disseminated tubercles. When treatment is carried out, chorioretinal scars remain.

Syphilitic– spreads in the fundus and is characterized by alternating pigmented foci with fibrous foci of atrophy.

Purulent- the result of immunodeficiency. This type is dangerous due to the spread of exudate to other sectors of the eyes. It has an immunodeficiency type, which is expressed by a large area of damage, hemorrhagic and necrotic in nature. Treatment of this type is very difficult, and the complication can result in complete blindness for the patient.

The remaining species have practically no distinctive features. However, myopic chorioretinitis can be distinguished in them. It is developing in the area macular spot, which is located on the surface of the retina. This happens due to repeated hemorrhages in the retina and retinochoroiditis of the eyes with a high degree of myopia.

Initial is characterized by:

the appearance of grayish-yellowish lesions with faint outlines,
the formation of exudate localized along the vascular network;
the appearance of hemorrhages.

When the disorder is developed, the following are observed:

lesions with strongly defined outlines;
their pigmentation;
atrophy of the retina and surface of blood vessels in the affected area;

Chorioretinitis mainly manifests itself due to:

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

It appears in the place where the source of occurrence is localized. It can be diagnosed by the following signs:

the field of vision becomes blurred;
visual acuity deteriorates;
dark areas appear;
there are flashes (photopsia);
sparks flash in the visual field;
the outlines and sizes of the objects in question are distorted (micropsia, macropsia, metamorphopsia);
difficulty in orienting at night (night blindness);
sensitivity to bright light sources increases;
the retina becomes cloudy;
painful sensations in the eye area are recorded;
color perception may change.

Each of these signs indicates the development of an eye disease, so the first time they are detected, you should immediately visit a doctor and carry out a diagnosis. It is also necessary to take into account the fact that some types can pass without symptoms, such as peripheral varieties.

To confirm the diagnosis, the following is carried out:

checking visual acuity, which worsens with central type lesions and cannot be corrected;
perimetry, as scotomas, dark spots may appear and sharp decline retinal sensitivity;
refractometry (does not change);
biomicroscopy (helps to determine whether there was deformation of the vitreous body or not);
examination of the eyes in transmitted light (vitreous opacity 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 inflammation site;
Ultrasound (using this procedure, the doctor identifies the state of the optical media).

Biomicroscopy

Doctors

If necessary, seek advice from:

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

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

For conservative treatment use various groups medicines:

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

Whenever bacterial types of drugs containing antibiotics are used. They help 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. If they are intolerant, 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 medications 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 administration, diprospan is prescribed. The dosage is determined by the attending physician.

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

Taking these drugs directly depends on how severe the inflammatory process is. For example, when active form immunosuppressants (mercaptopurine, fluorouracil) or immunostimulants (levamisole for HIV-infected patients) are used.

Thanks to them, hyposensitizing therapy is possible. For this we use:

suprastin;
claritin;
erius.

Prescribed to improve resistance to pathology:

ascorbic acid;
group B;
multivitamin complex.

To increase the speed of elimination of inflammatory processes, enzymes are prescribed.

Retrobulbar method is used:

hemase;
fibrinolysin;
histochrome;
lidase.

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

hemosorption;
plasmaphoresis.

Physiotherapy is used to speed up the healing process. Electrophoresis has an excellent effect among physiotherapeutic procedures. joint reception lidase, fibrinolysin.

Surgical intervention is relevant for:

spread of inflammatory processes;
the occurrence of complications.

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

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

The disease in question, if the treatment is inadequate, as well as if it is neglected, can result in serious complications for the patient:

retinal detachment;
formation of a neovascular membrane;
the occurrence of recurrent retinal hemorrhages;
thrombosis of the retinal venous network 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, consult a specialist;
periodically visit an ophthalmologist to check the health of the eyes (a child can visit an ophthalmologist already in the first three months from birth);
do not get into situations that could result in serious injury;
maintain eye hygiene;
sanitize foci of infection in the mouth and nasal sinuses.

Central chorioretinitis, tuberculosis or any other, is a rather difficult disease to treat. It has a large number of varieties and treatment will depend on the manifestation of one form or another. Amazes this disease at any age: adults get sick due to various reasons, and children tend to get sick when an infection develops.

As the pathology progresses without proper treatment, various kinds of 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 pathology. In this regard, the disease received another name - posterior uveitis, since it affects this particular part of the eye. If there is no proper treatment or it is started late, the inflammation becomes chronic. Nutritional disturbances in the eye occur because the choriocapillary vessels supplying it become inflamed. 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 occurs due to some structural features of the eye. Because in this area blood vessels are located on a wide bed, the movement of blood slows down. There are many ramifications to this. Stagnation in circulatory system allow those caught up in it to develop intensively pathogenic microorganisms. Infectious agents in large quantities are retained precisely in the posterior part of the eyeballs. The rapid proliferation of microorganisms leads to 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 larger vessels.

The causes of the development of an inflammatory process affecting 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.

The disease is caused by injuries to the organ of vision, as well as conditions leading to weakened immunity. This factor manifests itself due to prolonged treatment, as well as during HIV infection.

Most often, the penetration of the pathogen into ocular vessels occurs through the bloodstream. In this case, they say that chorioretinitis is acquired. But the disease can also manifest itself in a congenital form. This occurs due to intrauterine infection.

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

An autoimmune disease is considered quite rare form Posterior uveitis – Birdshot chorioretinopathy. The process of inflammation of the lining of blood vessels, as well as the retina, develops in this pathology in a progressive form. At the same time, it often shows resistance to treatment.

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

Chorioretinitis is classified according to the form of its course, area of distribution, number of foci, stages and pathogens.

Distribution area

Pathology may occur in different areas organ of vision. Based on this criterion, the disease is divided as follows:

If the macular region is affected (referring to the macula), then the disease is called central serous chorioretinitis of the eye.
When the pathology spreads near the optic nerve head, peripapillary lesions occur. If an oval-shaped focus of exudate occurs in the same area, the disease is considered juxta-papillary chorioretinitis. In this case, damage to the retinal vessels occurs, and the vitreous body is also affected.
Equatorial. This type of pathology is characterized by inflammation choroid, located near the equatorial region of the eye.
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. The disease is classified according to the number of foci:

Focal appearance. The inflammatory process is concentrated in one place.
Multifocal. Several areas of the eye are affected at once.
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 types with different durations:

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

The etiology of the disease also has great value for classification. Depending on this feature, the following are distinguished:

infectious nature of infection;
allergic manifestation, the causes of the manifestation are not related to infection;
post-traumatic – the disease developed as a result of trauma;
infectious-allergic type of lesion.

Infectious chorioretinitis is divided into subtypes depending on the pathogen.

The infectious type of pathology appears more often than other categories. In this case, four of its varieties are distinguished.

Toxoplasmosis type is a congenital type. Infection of a child occurs during the intrauterine development of the fetus. The cause is toxoplasmosis in the mother. This chronic disease. The lesion is clearly outlined.
The tuberculosis type of pathology is a secondary disease. It develops only in the case of pulmonary tuberculosis. After the therapy, a chorioretinal scar remains as a reminder of the disease. It may resolve over time in some cases.
Syphilitic chorioretinitis. The place of distribution is the fundus of the eye. At the same time, two types of lesions are clearly distinguished in their alternation: fibrous and pigmented. Such alternations make it possible to confidently determine a syphilitic lesion.
Purulent. AIDS is the “culprit” of this type of manifestation. With this type of disease purulent discharge spread to other sectors of the eye. In this variety, an immunodeficiency type is separately distinguished, in which a large area is affected.

It should be noted that the remaining species have almost no special distinctive features. However, it is worth highlighting myopic chorioretinitis separately. It manifests itself in 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 must be strictly met when it is necessary to perform work at close range.

Toxoplasmosis chorioretinitis is congenital. The baby becomes infected from the mother.

Stages

Characteristic features initial stage are:

the appearance of faint outlines of lesions with a yellowish tint;
purulent discharge forms along the network of blood vessels;
minor hemorrhages occur.

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

formation of lesion outlines;
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 last stage diseases.

Symptoms

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

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

appears increased sensitivity to the light;
“flies” float in front of your eyes;
in the dark, visual acuity decreases significantly, “night blindness” appears;
a nagging pain occurs in the eye area;
Tears often flow spontaneously.

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

Only a doctor can make a diagnosis of chorioretinitis, having in hand the results of diagnostic studies.

It is impossible to independently diagnose such a disease. The naked eye is not able to recognize chorioretinitis. This requires special tools and devices.

To make a diagnosis, the following activities are performed:

Checking visual acuity. With this pathology, the patient always begins to see worse.
Computer perimetry is performed. This check allows you to determine whether there are dark spots and what is the sensitivity of the fiber.
Biomicroscopy is performed. The procedure is necessary to detect changes in the vitreous.
Transmitted light reveals the presence of opacities.
To identify deep-seated lesions, ophthalmoscopy is performed. The border of the lesion is determined, and pigmentation is detected.
Vascular changes can be determined by angiography.
Diagnosis of the retinal condition is performed using electroretinography.

Diagnostic measures also include procedures such as optical tomography and ultrasound. The patient will be given a referral to donate urine, blood and Mantoux test. To check the condition of the lungs, fluorography is also necessary.

Often, the cause of chorioretinitis, as well as the symptoms that appear, and treatment is prescribed accordingly. Therapy for chorioretinitis is carried out purely individually. Required local procedures and injections. Among the medications it should be noted etiotropic drugs. Their focus should be on the main cause of the pathology. To identify the pathogen, a broad-spectrum antibiotic is prescribed.

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

At viral infection requires taking antiviral drugs. Antibiotics used for syphilis penicillin group. 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 mouth. If toxins are detected (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 condition, Diprospan is used to relieve inflammation.

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

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

In the absence positive results possible use surgical intervention. IN recent years Lasers are increasingly being used for this purpose. The duration of the operation does not exceed twenty minutes.

Any universal folk way There is no cure for this 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 echinacea tincture.

When a diagnosis of choriretinitis is made, the patient’s first question is whether the disease can be cured. If therapy is started in a timely manner, the prognosis is favorable. This approach is the basis of prevention. In addition, it is necessary to be regularly examined by an ophthalmologist.

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

Nov 28, 2017Anastasia Tabalina

- inflammation posterior section 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. Diagnostics is based on bacteriological culture, ELISA, determination of C-reactive protein, gonioscopy, angiography, perimetry, ophthalmoscopy. Conservative therapy includes the prescription of antibacterial agents, non-steroidal anti-inflammatory drugs, mydriatics, glucocorticosteroids, biogenic stimulants and reparants.

Diagnostics

The diagnosis is based on anamnestic data, results of instrumental and laboratory methods research. 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. Promotion 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. Bounded Area Detection white indicates atrophy. The macula area is 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. At dystrophic changes In the macula, there are no signs of inflammation and vitreous opacification. 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, surgical intervention is required, which is aimed at plasticizing the bone wall of the orbit and comparing displaced fragments. Before surgery and early postoperative period a short course of antibiotics is indicated. Conservative therapy comes down to the following:

Non-steroidal 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 carried out in case of toxoplasmosis nature of chorioretinitis, as well as in case of accession 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 chronic course Physiotherapeutic procedures are prescribed for illnesses. Calcium chloride is introduced using electrophoresis, antibacterial agents, proteolytic enzymes plant origin. At the stage of pathology resolution it is used ultrasound therapy on the losing 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.

Chorioretinitis is a form of posterior uveitis in which the choroid and its retina become inflamed. Delayed treatment may cause severe complications, including vision loss and.

What kind of disease is this?

Chorioretinitis maybe like acquired, so congenital disease.

There are acute and chronic forms.
If the inflammation is localized in the macular area, then it is called central , near the optic nerve head – peripapillary , in the equator zone – equatorial , and near the spongy line – peripheral .

Central chorioretinitis: photo

The cause of this disease may be:

allergy;
infection (often toxoplasmosis or cytomegalovirus, herpes, syphilis);
autoimmune disease;
radiation;
injury;
toxic damage;
immunodeficiency (HIV, weakened immunity after a serious illness).

Depending on the cause of the disease, there are different forms. For example, there is toxoplasmosis chorioretinitis of the eyes, syphilitic, tuberculous.

Chorioretinitis may be asymptomatic. The disease in such cases is detected during a medical examination.

If the disease affects the macular area, then the following manifestations are possible:

blurred vision;
reducing its severity;
distortion of visual perception of the shape and size of objects;
sparks or flashes before the eyes;
poor orientation at dusk.

Video:

ICD-10 code

Chorioretinitis is an eye disease and adnexa related to international classification to block H00-H59. As a disease of the choroid and retina (H30-H36), chorioretinitis is positioned as chorioretinal inflammation and is designated class H30.

Chorioretinal inflammation of a focal nature is designated by coding H30.0, disseminated - H30.1, unspecified – H30.9.

Diagnostics

To clarify chorioretinitis, several diagnostic methods are used:

vision assessment (reduced, not corrected);
(decreased contrast sensitivity of the retina, dark spots);
Ultrasound diagnostics;
biomicroscopy (vitreous disorders);
refractometry;
fluorescein angiography (vascular assessment);
electroretinography;
Optical coregent tomography (retinal check).

Photo of an inflamed eyeball

In diagnosing chorioretinitis, it is also important to establish the causes of its occurrence. To do this:

urine test;
blood tests (general, RW, various infections);
fluorography of the chest.

Depending on the characteristics of the disease, sometimes they consult with other specialists, for example, an ENT doctor, a venereologist, an immunologist.

Treatment

When diagnosed with chorioretinitis, the patient’s first concern is whether the disease can be cured. Treatment is possible, but it must be started promptly and correctly. Only there can you preserve your vision and avoid complications.

To eliminate the causes of the disease, they resort to etiotropic drugs. If the causes are bacterial, antibiotics are included in treatment wide range, and after identifying the pathogen, they move on to a more specific drug.

You can speed up the resorption of inflammation with the help of enzymes - histochrome, lidase, fibrinolysin. Treatment of chorioretinitis also includes anti-inflammatory therapy. Part of it are hormonal agents – Diclofenac, Hydrocortisone, Indomethacin. The drugs are administered parabulbarly, intramuscularly or used topically.

Inflammation caused by toxins requires detoxification therapy, for example, with a 5 percent glucose solution or hemodez.

In terms of immunotherapy, treatment may be carried out with immunosuppressants or immunostimulants. Helps increase the body's resistance vitamin complexes(B vitamins and ascorbic acid are required).

Physiotherapy helps speed up treatment. Electrophoresis with lidase is the most effective.

Central serous chorioretinitis implies the inclusion in therapy of drugs to normalize capillary permeability (usually ascorutin), dehydration agents (glycerol, glucose solution) and vasodilators(No-Shpa).

Treatment with folk remedies

It is possible to treat chorioretinitis with folk remedies, but it should only be an addition to drug therapy. Apply folk remedies in order to dilate blood vessels.

During the treatment process, it is important to consider your diet. Must be consumed fresh vegetables, cottage cheese, fermented milk products, citruses. If possible, you should include blueberries, black currants and rose hips in your diet.

With a timely and correct approach, chorioretinitis can be completely cured.

It is important to remember that for any health problems you need to contact a specialist. Even seemingly minor violations can lead to serious consequences and serious complications.

You need to take care of your eye health. This is primarily due to the fact that the condition of the eyes is visual acuity. There are known diseases that change or distort some worldview. However, there are diseases that can radically deprive not only vision, but also the eyes.

What is chorioretinitis?

What is chorioretinitis? This is inflammation back wall choroid and retina.

Classification

The classification of chorioretinitis according to the forms and types of its development should be considered:

Based on the affected area, they are divided into types:
- Central – macular region.
- Peripapillary – optic disc.
- Equatorial - equator.
- Peripheral - the border of the dentate line.
The types are divided according to the number of foci:

Focal - one area is inflamed.
Multifocal disseminated - inflammation of several areas.
Diffuse - several foci merging.

According to the duration of the flow, the following forms are distinguished:

Acute – up to 3 months.
Chronic – more than 3 months.

According to pathogens, chorioretinitis is infectious:

Toxoplasmosis is congenital, transmitted from the mother. It is chronic. Affects the central nervous system and other organs besides the eyes.
Syphilitic - alternating places with fibrosis and atrophy.
Tuberculous - develops only in the presence of tuberculosis in the lungs. Disseminated tubercles and chorioretinal scars are formed.
Purulent - is the result of immunodeficiency. Dangerous due to the possibility of exudate spreading to neighboring parts of the eye.
Immunodeficiency (in HIV-infected people).
Infectious-allergic.
Non-infectious-allergic.
Infectious.
Post-traumatic, etc.

Reasons

What causes a disease such as chorioretinitis? Let's list them below:

from other inflamed organs, for example, with tuberculosis, pneumonia, meningitis, HIV, etc.
Complications of myopia.
Mechanical damage to the eye.
Allergic reaction.
Autoimmune condition.
Exposure to radiation.
The influence of chemicals and medications.
Immune deficiency.

Infection often causes chorioretinitis. In these parts of the eye, bleeding is slow, so when an infection is transmitted through the bloodstream, it accumulates in the eye, causing various diseases.

Symptoms and signs of chorioretinitis of the posterior wall of the choroid and retina

With chorioretinitis of the posterior wall of the choroid and retina, no changes are observed in the anterior parts of the eye. By what symptoms and signs can a disorder be identified?

Minor or strong decline vision, as with uveitis.
The appearance of flashes that do not exist in reality (photopsia).
"Night blindness" - decreased vision in dark time days, as with retinitis.
Deformation of the shape of the perceived object.
The appearance of flies before the eyes.

Chorioretinitis in children

In children, chorioretinitis can occur due to the spread of infection throughout the body or due to eye injuries. Other reasons are adult. You should not self-medicate here, which can aggravate the child’s condition and lead to loss of vision.

Chorioretinitis in adults

In adults, chorioretinitis often occurs due to improper use of lenses (in women) or constant contact with chemicals(in men). Let’s not forget about reduced immunity, which adults usually don’t take care of until illness puts them to bed.

Diagnostics

Diagnosis of chorioretinitis begins with contacting an ophthalmologist with complaints. The patient tells what worries him, and the doctor conducts a general examination, vision test and additional tests:

Perimetry.
Refractometry.
Transmitted light research.
Biomicroscopy.
Urinalysis.
Ophthalmoscopy using a Goldmann lens.
Fluorescein angiography.
Electroretinography.
Ultrasound of the eye.
Blood test.
Fluorography of the sternum.
Mantoux test.
CT eye.

Treatment

Treatment of chorioretinitis is carried out depending on the causes of its occurrence. How to treat inflammation of the retina and posterior wall of the choroid? Following procedures and medications:

Retrobulbar and parabulbar injections.
Anti-inflammatory drugs.
Immunosuppressors and immunostimulants.
Antibiotics and antiviral drugs, depending on the pathogen.
Antiallergic medications.
Detoxification.
Electrophoresis with lidase and fibrinolysin.
Laser coagulation of the retina.
Antihistamines.
Taking vitamins B and C.
Plasmapheresis and hemosorption during heavy currents diseases.
Enzymes.
The use of corticosteroids to eliminate inflammatory processes.
Mydriatic drugs improve fluid outflow and dilate the pupil.

Vitrectomy is used when complications occur - retinal detachment and membrane changes.

At home, no methods, diets or methods traditional treatment won't help. We are talking about damage to departments that cannot be reached with lotions or decoctions. It’s better not to delay, so as not to bring the disease to the point of we're talking about often about reduced immunity, then here you should start replenishing your body with vitamins. There are no other food restrictions.

Life forecast

Chorioretinitis is a dangerous disease. How long do patients live? The disease does not shorten life, but significantly reduces its quality. Complications of untimely or untreated disease are:

Retinal detachment.
Recurrent retinal hemorrhages.
Neovascular membrane.
Retinal vein thrombosis.
Blindness.

In this case we speak about the need timely treatment if an illness occurs, or about preventive measures:

Do not injure your eyes.
Treat all eye diseases.
Treat diseases of other body systems.
Contact an ophthalmologist at the first symptoms of the disease.

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 during early age, they can make themselves felt much later. Along with eye damage, other disorders also occur. Most often suffers nervous system.

Usually to formation of this disease gives several conditions:

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

If the disease does make itself felt, then vision noticeably deteriorates.
The picture before my eyes is no longer as clear as before.
A shroud, glare, flashes, and dark spots may appear.
In some cases, objects in front of your eyes may be visually distorted.
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 acute period It is difficult to notice such changes; their boundaries are unclear.

At active process 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 medical diagnosis is indispensable.

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

The doctor checks visual acuity. With chorioretinitis, vision always deteriorates.
Computer perimetry. Helps to identify how much the sensitivity of the retina is reduced and whether dark spots are present.
Biomicroscopy. This procedure helps determine whether changes are present in the vitreous.
Transmitted light examinations will help identify the presence of opacities.
Ophthalmoscopy. Helps to examine even the deepest lesions. With the help special lens occurs . This helps to see clear boundaries of the lesion and identify pigmentation.
Angiography is used to determine vascular changes.
Electroretinography diagnoses the condition of the retina.
Using optical tomography, the doctor determines the intensity of inflammation.
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 is evidence 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:

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. Treated with folic acid and sulfadimezine. For disorders caused by tuberculosis, a TB doctor is needed.
The disease can be treated with anti-inflammatory and hormonal medications intramuscularly, intravenously or orally.
In case of poisoning and detection of toxins, detoxification is carried out.
In case of weakened immunity, immunostimulants are taken. The patient must be kept healthy and active image life, eat right, eat foods that boost immunity, spend more time in the fresh air.
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 a dangerous disease. Without proper treatment, it is possible to get retinal detachment, retinal bleeding, complete loss vision. In order to avoid such consequences, it is important to diagnose the disease in time and begin drug and therapeutic treatment.