Doctors understand by the term retinitis an inflammation of the eye retina. Triggered by various factors, it can lead to complete loss of vision as it progresses.
What is retinitis?
Retinitis is an inflammation of the retina, often triggered by infections. The course of the disease can be characterized by harmless symptoms, but can also lead to complete blindness.
Causes
In most cases, retinitis is caused by inflammation that spreads to the retina. The damaged retina progressively degenerates as the fine tissue gradually recedes. Often, this inflammation is triggered by an infection. A herpes simplex virus is detectable in the secretion of tear fluid. It can manifest in the retina and cause localized foci of inflammation that rapidly lead to blindness. Herpes simplex retinitis is often seen following HSV disease, but may occur months or years later. Lyme disease, triggered by the bite of a tick, is also suspected. The causes for the development are manifold. Genetic factors or massive mechanical impact also play a role
Symptoms, complaints and signs
The body reacts to inflammation with certain stimuli. It thus recognizes the harmful foreign substances and thereby shows inflammation symptoms such as tissue swelling, redness or heat development to fever. Numerous defense processes interlock. The swelling of the tissue is caused by an increased fluid content, which is intended to flush harmful pathogens out of the body. Thus, in retinitis, the reddening of the retina leads to increased blood flow and at the same time better supply of the tissue. The generation of heat during inflammation is an enormous effort for the organism, whereby various metabolic processes also cause damage to the tissue. Normally, the body repairs these after the acute phase. If the repair is successful in retinitis, the inflammation subsides without any adverse effects. The retina can recover and the affected eye is fully functional again. However, if the process fails to produce a normal response, permanent damage can sometimes be expected.
Diagnosis and course of the disease
Once a suspected diagnosis is established, the exact course of the disease is often still unclear in retinitis. For this purpose, the respective triggers of the disease must first be determined. Furthermore, retinitis is divided into subgroups with different specifications or classifications. There is retinitis centralis, in which mainly the central retinal area is affected. Thus, the entire surface of the eye is not affected here, but only the retinal center. This area contains a large number of visual cells that are responsible for focusing the optical image. A severe course of retinitis centralis is therefore usually associated with permanent damage and loss of vision for the central field of vision of the affected eye. Retinitis with hemorrhages are known as retinitis haemorrhagica. Sepsis (blood poisoning) can result in septic retinitis. and retinitis syphilitica, is the result of syphilis. Choroiditis (inflammation of the choroid) is often seen in association with retinitis exsudativa. Typical symptoms are pronounced water retention in the tissue (edema), occasionally also bleeding. In the further consequence conditional retinal detachments show up, which lead immediately afterwards to failure symptoms in the central area of the retina. Retinitis can also cause Harada syndrome. In this case, meningoencephalitis (inflammation of the meninges and brain) is also present. The symptoms are the typical balance disorders, hearing problems, loss of pigment and hair loss. Almost every tenth affected person does not survive the constellation of retinitis with meningoencephalitis. Numerous examination methods are available to detect retinitis with its multiple manifestations. First and foremost, the eye is examined using a slit lamp for the anterior, middle, and posterior regions of the eye. To visualize the fundus of the eye, specular examination is performed with the aid of an ophthalmoscope. The spectrum of diagnostic methods ranges from the measurement of intraocular pressure, corneal topography to the determination of the resolving power of the retina by means of a retinometer.
Complications
Retinitis presents as a symptom of various diseases. Therefore, the possible complications depend on the underlying disease. Often, retinitis is even asymptomatic. In severe cases, however, it can lead to blindness. The underlying diseases can be both hereditary and acquired. Acquired forms of retinitis are often caused by infections or autoimmune diseases. Certain forms of retinitis can lead to many small hemorrhages in the retina. Especially diabetics have a higher risk of developing retinitis haemorrhagica (retinal hemorrhages). Retinitis is often associated with choroiditis, which is characterized by water retention in the tissue, small hemorrhages in the retina, and retinal detachments. Retinitis also develops in the context of the so-called Vogt-Koyanagi-Harada syndrome. This is a disease that is directed against the body’s own melanocytes due to an autoimmune reaction. This form of retinitis is associated with meningitis, pigmentary abnormalities, hair loss, and increased sensitivity to high-pitched sounds. Vogt-Koyanagi-Harada syndrome leads to death in ten percent of cases. Sometimes vision can be severely impaired in the various forms of retinitis even after the inflammation has healed. This is especially the case if scarring has formed on the cornea. These can lead to ulcers and small tears, which then form the basis for severe visual complaints.
When should you go to the doctor?
Since retinitis does not heal on its own, this disease must be examined and treated by a medical professional in any case. Only a medical examination can prevent further complications. A doctor should be consulted for retinitis if the affected person suffers from significant swelling in the area of the eyes. If the swelling does not go away on its own, a doctor should always be consulted. This may also interfere with the affected person’s field of vision. Since this disease is an inflammation, it may also be accompanied by fever. As a rule, retinitis is treated by an ophthalmologist. There are no particular complications and the course of the disease is usually positive. The life expectancy of the patient is also not limited by the disease. However, in the worst case, the affected person may lose vision completely if retinitis is not treated.
Treatment and therapy
In preparation for treatment and therapy, the specialist will determine possible risk factors during an intensive medical history interview. The information about current diseases, infectious processes or genetic hereditary diseases within the family is urgently needed for the further course of treatment. Depending on the causative disease, the individual therapy is carried out. If retinitis is caused by bacteria, antibiotics are used. This is the case, for example, with the involvement of choroiditis (chorioretinitis). In this case, eye drops containing antibiotics are usually administered. In the case of a viral infection, antivirals help. In rare cases, after the inflammation has subsided, scarring forms on the cornea of the eye. This leads to the formation of ulcers or even small tears in the cornea, which are hardly noticed at first, but later cause enormous visual complaints. In a surgical procedure, an amniotic membrane (tissue obtained from the placenta) is sewn onto the affected area. This acts like an anti-inflammatory protective layer and at the same time supports the healing of the eye through certain wound healing substances. The procedure, which takes only a few minutes, is performed under local anesthesia Once the tears under the protective membrane have healed, the amniotic membrane is removed.
Prevention
Retinitis often occurs at a late stage as a result of infectious diseases or other health conditions. Therefore, prevention of retinitis is not possible. However, the immune system can be strengthened to fight off viruses and bacteria. General measures include a healthy lifestyle with a balanced diet, sports activities, outdoor activities and adequate rest.However, if abnormalities occur in the eye with pain and redness, medical advice should be sought as soon as possible. Regardless of this, regular check-ups with an ophthalmologist protect against nasty surprises.
Follow-up care
The primary goal of follow-up care for retinitis is to preserve eyesight. Progressive detachment of the retina and rapid destruction of photoreceptors should be slowed, as they would lead to blindness in the long term. Approximately half of the patients also suffer from a clouding of the lens (cataract) during the course of the procedure. Here, too, preventive measures can be taken in the course of follow-up care. The disease is hereditary, and there is currently no cure. If the diagnosis is made when the affected person is still young, the treatment options are even greater than at a later stage. In the follow-up treatment, the ophthalmologist must take into account the current condition of the patient. Some of those affected are almost free of symptoms. Other sufferers, in whom retinitis is already far advanced, are already severely limited in their ability to see. At this stage, not only the rods but also the cones of the retina are affected. Depending on the severity of the symptoms, patients are treated during follow-up. If the symptoms of retinitis place a heavy emotional burden on the sufferer, psychotherapeutic care is also recommended. This involves working out ways in which the affected person can cope more easily with everyday life despite the visual impairment. The development of depression is also treated preventively during therapy sessions.
What you can do yourself
Retinitis cannot yet be treated causally. The only effective therapy is to slow the progression of the disease and relieve symptoms. Sufferers can improve their quality of life by consulting closely with their ophthalmologist and having their special glasses adjusted regularly. Special edge filter lenses with UV protection provide additional protection for the eyes. This can be accompanied by orientation and mobility training. In this context, those affected learn how to move around and orient themselves with limited vision. Individual complications such as cataracts or cellular disorders of the macula lutea must be treated individually. In everyday life, patients should also ensure sufficient rest and relaxation. Retinitis represents a great psychological burden, which can considerably reduce the quality of life. It is therefore all the more important to compensate for this loss by leading a full life. Affected individuals must take advantage of regular progress monitoring by their physician and, moreover, contact various specialists, as new treatment options for retinitis pigmentosa are always being developed that could be considered for patients with the necessary basic conditions.
