Retinal vasculitis associated with systemic disorders and infections
- Michael Tolentino, MD
Michael Tolentino, MD
- Director of Clinical Research
- Center for Retina and Macular Disease
- Associate Professor, Ophthalmology
- University of Central Florida
- Reza Dana, MD, MPH, MSc
Reza Dana, MD, MPH, MSc
- Claes Dohlman Professor of Ophthalmology
- Harvard Medical School
- Section Editors
- Peter A Merkel, MD, MPH
Peter A Merkel, MD, MPH
- Section Editor — Vasculitis
- Chief, Division of Rheumatology
- University of Pennsylvania
- Jonathan Trobe, MD
Jonathan Trobe, MD
- Section Editor — Ophthalmology
- Professor of Ophthalmology and Visual Sciences
- Professor of Neurology
- University of Michigan Kellogg Eye Center
Retinal vasculitis is characterized by inflammation of the vessels of the retina . Positive findings on fluorescein examination may be diagnostic, with fluorescein angiography demonstrating vascular leakage (perivascular staining) and capillary nonperfusion.
The detection and characterization of retinal vasculitis may help in the diagnosis and management of certain disorders associated with ocular inflammation. These include systemic autoimmune disorders, some infectious diseases, and certain ocular disorders.
This topic will review the clinical features of retinal vasculitis associated with systemic disorders and infections. Vasculitis of the retinal vessels due to local ocular inflammatory disorders and an overview of the classification of vasculitis are discussed separately. (See "Retinal vasculitis associated with primary ocular disorders" and "Overview of and approach to the vasculitides in adults".)
The classic symptom of retinal vasculitis is a painless decrease in vision. Other symptoms may include a blind spot from ischemia-induced scotomas or floaters from vitritis. With macular involvement, patients may present with metamorphopsia (change in shape of an object) or abnormalities in color vision. Retinal vasculitis can also be asymptomatic.
Physical examination — Abnormalities in the retinal vessels may be observed upon physical examination. Fundoscopic findings include vascular sheathing (visible accumulation of inflammatory cells along vessel walls) (picture 1) and vitreous hemorrhage. The peripheral vessels are often more involved than central arteries and veins, and there are frequently skip areas. With certain disorders such as sarcoidosis, lesions resembling candle-wax drippings or extensive perivascular inflammation may also be observed.
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- CLINICAL CHARACTERISTICS
- Physical examination
- DIAGNOSIS AND DIFFERENTIAL DIAGNOSIS
- SYSTEMIC DISEASES
- Behçet's syndrome
- Systemic lupus erythematosus
- Giant cell arteritis
- Granulomatosis with polyangiitis (Wegener's)
- Polyarteritis nodosa
- HLA-B27-associated conditions
- Relapsing polychondritis
- Inflammatory bowel disease
- Multiple sclerosis
- INFECTIOUS CAUSES
- - Treatment
- Whipple's disease
- SUMMARY AND RECOMMENDATIONS