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Aetiology

• Infectious causes:
  • Bacteria: Syphilis, Lyme disease, Bartonella henselae, Tuberculosis, Leprosy, Tropheryma whipplei, Propionibacterium acnes
  • Viruses: Cytomegalovirus (CMV), Varicella-zoster virus (VZV), Herpes simplex virus (HSV), Influenza A, Measles, Mumps, Rubella, Coxsackie B, Epstein-Barr virus (EBV)
  • Parasites: Toxoplasmosis (most common in adults)
  • Fungi: Candida, Pneumocystis carinii
  • Others: Toxocara, Cysticercosis, Onchocerciasis, Ophthalmomyiasis (fly larvae), DUSN (Diffuse Unilateral Subacute Neuroretinitis)
• Inflammatory: White-Dot-Syndromes:
  • Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE)
  • Multiple Evanescent White Dot Syndrome (MEWDS)
  • Serpiginous Choroidopathy
  • Birdshot Retinochoroidopathy
  • Multifocal Choroiditis with Panuveitis
  • Punctate Inner Choroidopathy (PIC)

Findings

• Vitritis, choroiditis (focal, multifocal, or diffuse), retinitis/retinal lesions, vasculitis (perivascular sheathing), neovascularisations, macular edema, papillitis, optic disc swelling, granulomas, pigmentary changes
• Visual impairment with macular involvement

Work-up

• Laboratory: Differential blood count, CRP, ESR, ANA, ACE, syphilis, Quantiferon test
• Chest X-ray.
• For suspected Birdshot retinopathy: HLA-A29.
• For retinitis/choroiditis: Toxoplasmosis, CMV, HSV, VZV IgM/IgG (consider AC/vitreous tap, PCR), HIV
• For papillitis: Additionally Bartonella, Borrelia, toxoplasmosis IgG/IgM
• In children: Possibly Toxocara serology
• For vasculitis: Additionally ANCA, anti-cardiolipin antibodies

Treatment

• According to the etiology (see separate articles)

Sources

• The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Nika Bagheri MD, Brynn Wajda MD, et al; Lippincott Williams&Wilkins; 7th Edition (2016)
• Kanski’s Clinical Ophthalmology: A Systematic Approach; Jack J. Kanski MD, Brad Bowling MD; Saunders Ltd.; 8th Edition (2015)