Chorioretinitis is a serious inflammation of the back of the eye that can have many causes. Without medical treatment, there is a risk of permanent vision problems. In the worst cases, blindness occurs as a result of chorioretinitis.
What is chorioretinitis?
Chorioretinitis refers to inflammation of the retina and choroid of the eye. The retina consists of light-sensitive sensory cells as well as the discharging nerve cells. The intensively supplied choroid supplies the retinal tissue with nutrients and oxygen. The close connection between the retina and the choroid almost always leads to joint involvement of both tissue layers in inflammatory events in the eye. In this case, the inflammation foci appear as bright, yellowish-white spots mostly scattered (chorioretinitis disseminata). Infection over the entire surface of the retina and choroid is rarely observed, as is isolated inflammation of the “yellow spot” (chorioretinitis centralis). This central region of the retina is the site of highest optical resolution. Chorioretinitis may also selectively affect the optic nerve entry site (chorioretinitis juxtapapillaris). Precipitation of proteins into the vitreous of the eyeball is a general accompaniment of chorioretinitis.
Causes
Chorioretinitis is a disease that can have many infectious triggers. Bacteria and viruses are possible causative agents, as are mycoses (fungal infections). Therefore, the disease often occurs as a consequence of other infections. Herpes, borreliosis, rubella or syphilis are some of the most common pre-existing diseases of chorioretinitis. Typically, patients also include many HIV-infected individuals in whom AIDS has already developed. Finally, blood poisoning always carries the risk of chorioretinitis. Even unicellular animal parasites cause the dangerous inflammation of the back of the eye (toxoplasmosis) in some cases. Occasionally, autoimmune reactions also cause chorioretinitis. In this variant, the immune system attacks the body’s own substances in the retina and choroid. In this case, the physician refers to it as rheumatoid chorioretinitis.
Symptoms, complaints, and signs
In the worst case, chorioretinitis can cause permanent visual impairment or even complete blindness in the patient. However, this case occurs only if the disease is not treated. Chorioretinitis primarily leads to severe inflammation of the eye. Not only the retina is inflamed, but also the choroid of the patient. This leads to pain in the eye and in many cases also to visual disturbances, which can have a very negative effect on the patient’s quality of life. If the chorioretinitis continues to be ignored, complete blindness eventually occurs, which can no longer be treated and is therefore irreversible. Hemorrhage can occur on the vitreous itself, which can also lead to visual complaints. The affected persons suffer mainly from veil vision or double vision. If the visual complaints are severe, the affected persons may be dependent on the help of other people in their daily lives. Chorioretinitis can also lead to psychological complaints. These occur mainly when chorioretinitis is not treated and permanent damage to the eye occurs. Young people in particular are affected by the psychological complaints in this case.
Diagnosis and course
Chorioretinitis is diagnosed by the physician in the ophthalmoscopic examination. Thus, the physician looks into the eye with a slit-lamp microscope and looks for opacities in the vitreous body, which give rise to the suspicion of chorioretinitis. Clear indications are the bright, bulging foci of inflammation in the back of the eye. Imaging with contrast agents provides further evidence of chorioretinitis. Often, chorioretinitis is diagnosed too late because there are no symptoms in the early stages of the disease. Only when the yellow spot is affected or in the advanced stage does the patient notice visual disturbances. If the visual field has already been reduced, there is a risk of permanent visual impairment. In a milder course, the opacities in the vitreous may disappear. Minor scarring in the retina does not necessarily lead to visual impairment. Early treatment of chorioretinitis is often decisive for a favorable course.
Complications
Chorioretinitis can cause complications to the eye. It usually leads to visual defects if it is not treated. In the worst cases, there is complete loss of vision, leading to blindness. Due to the reduction of vision, the patient’s quality of life is reduced. In most cases, however, chorioretinitis does not cause pain. The affected person complains of veil vision and cloudiness in the eyes. The visual defects may also cause headaches and impaired concentration. There is also secretion formation in the affected areas. In most cases, treatment is possible, which leads to success relatively quickly. It is usually carried out with the help of antibiotics and does not lead to further complications or discomfort. It is only important that the patient starts the treatment at an early stage. Eye drops or injections can also be administered in severe cases. Chorioretinitis does not lead to a reduced life span. Only severe infections result in significant loss of vision or complete blindness. In these cases, the patient is dependent on various aids to still cope with everyday life.
When should you go to the doctor?
A physician should be consulted promptly if vision is impaired and there is visible eye redness. Chorioretinitis can lead to blindness if left untreated and must therefore be clarified without fail. Medical advice is required at the latest when the visual disturbances worsen and there is, for example, veil vision or a clouding in the eyes. Herpes, borreliosis, rubella and syphilis are among the typical pre-existing diseases of chorioretinitis. Also HIV-infected persons, in whom the AIDS virus has already broken out, as well as people with blood poisoning often fall ill with the eye inflammation. For these risk groups, the following applies: in case of redness, visual disturbances and other unusual symptoms, talk to the responsible physician. If vision problems occur as a result of an autoimmune disease, the patient may have rheumatoid chorioretinitis, which must also be clarified and treated. In any case, the patient should consult the ophthalmologist regularly to rule out complications. If permanent visual disturbances or complete blindness have already set in, psychological help may also be useful.
Treatment and therapy
Chorioretinitis requires rapid intervention against the inflammation. Thus, cortisone preparations are the first drug of choice for all forms of the disease. Once the physician has identified a specific pathogen as the cause, he or she will prescribe a specific antidote. These are then either antibiotics or antivirals and, if necessary, antifungals. The drugs are administered as eye drops or injected directly into the eyeball through the conjunctiva. In this way, the pharmaceuticals optimally reach their site of action. Oral dosage forms are supposed to have a “systemic” effect, i.e. via the organism’s pathways with its bloodstream. Laser treatment is indicated in cases of severe damage to the retina. This can help to avert or limit permanent visual impairment. This is because detachment of the retina is also a possible consequence of chorioretinitis.
Outlook and prognosis
In most cases, chorioretinitis can be treated relatively well. Only without treatment can it cause serious symptoms and complications. If the disease is not treated, permanent visual complaints and, in the worst case, complete blindness may result. This is still not reversible and cannot be treated. In chorioretinitis, patients suffer from an inflammation of the eye, which is accompanied by visual disturbances. The vitreous body appears clouded, which also has a negative effect on the vision of the affected person. In some cases, chorioretinitis may also cause scarring of the retina, which, however, does not always lead to visual complaints. The treatment of chorioretinitis proceeds without complications and is carried out with the help of eye drops. This completely relieves the symptoms. In case of early treatment, they disappear completely and there is no permanent damage. In case of severe damage to the retina, laser surgery can also be performed, which can alleviate the visual symptoms. Regular check-ups with an ophthalmologist can prevent chorioretinitis.It does not negatively affect the quality of life of the affected person.
Prevention
Chorioretinitis is very difficult to prevent with individual measures due to its multiple triggers. Patients at risk should participate in preventive examinations by an ophthalmologist. This is an option for people who have experienced one of the relevant infectious diseases (see above). Also persons from families, in which rheumatism occurs frequently, belong to the endangered population segment. Such checks are also particularly advisable for people infected with HIV. Likewise, people who have to take medication to reduce immune reactions (immunosuppressants) should consult their ophthalmologist regularly. Early detection is the best means of combating chorioretinitis.
Follow-up
In chorioretinitis, there are usually no special measures of aftercare available to the affected person. In this regard, the patient should seek medical attention at the first symptoms and signs of the disease to prevent further complications or further worsening of symptoms. If chorioretinitis is not treated, in the worst case it can even lead to complete blindness, which is no longer reversible. As a rule, the disease is treated by taking medication and eye drops. The affected person should always ensure that the medication is taken correctly and regularly so that the symptoms can be alleviated. It should also be noted that alcohol should not be taken together with these medications. However, if this treatment of chorioretinitis is not effective, laser surgery must be performed. However, the disease cannot be completely cured by this, so that the affected person is still dependent on visual aids afterwards. These should be worn regularly so that the eye muscles are not unnecessarily strained. Since chorioretinitis can lead to blindness, psychological treatment should also be given to prevent depression or psychological upset. However, the patient’s life expectancy is not reduced by the disease.
This is what you can do yourself
For patients with chorioretinitis, an immediate visit to the doctor is necessary to avoid permanent damage to visual function. If treatment for chorioretinitis is left untreated or begins too late, affected individuals may suffer from vision limitations for the rest of their lives. Therefore, chorioretinitis is by no means treatable independently, but should be treated by an ophthalmologist. In order to support the medical therapy of the eye disease in the best possible way, patients take time off for a few days to give the inflamed eyes the opportunity to regenerate. Chorioretinitis is often treated by injection into the eye. While the eye is to be spared even before the procedure, this principle applies especially to the time after the treatment. Under no circumstances should patients drive themselves after therapy. Instead, patients should be as passive as possible for the rest of the day and not put any additional strain on their eyes. Therefore, it is forbidden for patients to watch television or look at computer screens at home. At best, patients sleep as much as possible and refrain from physical activities. To restore visual function, it is useful to take a break from work for a few days to help the eyes recover.
