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Retinal vasculitis associated with systemic disorders and infections

Authors
Michael Tolentino, MD
Reza Dana, MD, MPH, MSc
Section Editors
Peter A Merkel, MD, MPH
Jonathan Trobe, MD
Deputy Editor
Monica Ramirez Curtis, MD, MPH

INTRODUCTION

Retinal vasculitis is characterized by inflammation of the vessels of the retina [1]. 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".)

CLINICAL CHARACTERISTICS

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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Literature review current through: Nov 2016. | This topic last updated: Thu Oct 02 00:00:00 GMT+00:00 2014.
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