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Chorioretinitis

Last updated March 4, 2020

Reviewed by: Nizamuddin SHM, MD, FRCS

Approved by: Krish Tangella MD, MBA, FCAP

Chorioretinitis, as the name indicates, is an eye condition that results in the inflammation of both the choroid and the retina.


What are the other Names for this Condition? (Also known as/Synonyms)

  • Inflammation of the Choroid and Retina

What is Chorioretinitis? (Definition/Background Information)

  • Chorioretinitis, as the name indicates, is an eye condition that results in the inflammation of both the choroid and the retina. As per definition, the involvement of the choroid occurs first and is followed by the retina that is affected later
    • Choroid: It is a portion of the uvea (a pigmented layer in the eye) that is predominantly made up of blood vessels. The choroid provides nutrients to the retina, keeping it healthy
    • Retina: It is a layer of tissue situated at the back of the eye that helps in sensing light. When the blood supply to the retina is blocked, it will not be able to receive enough blood and oxygen leading to the loss of vision
  • Chorioretinitis is described as a form of posterior uveitis, a condition involving inflammation of the choroid (part of uvea). It can be caused by both infectious and non-infectious factors and any individual may be affected. However, most commonly, Chorioretinitis develops from exposure to the pathogens Toxoplasma gondii (protozoa) or cytomegalovirus (CMV); it usually appears as an outcome of a previous infection
  • The signs and symptoms of Chorioretinitis depend on the underlying cause, but may include eye floaters, blurred vision, sensitivity to light, and partial vision loss. A healthcare provider may use physical exams, eye exams, and various blood tests to diagnose Chorioretinitis. Upon diagnosis, appropriate treatment options involving steroids and/or immunomodulators may be used
  • Additionally, the healthcare provider will address any underlying conditions that may be contributing to the development and progression of Chorioretinitis. An immediate medical attention is sought to achieve better outcomes and prevent complications such as glaucoma and cataract
  • The prognosis for Chorioretinitis depends on the severity of the signs and symptoms and may be assessed on a case-by-case basis. With early and appropriate treatment, the prognosis is generally good

Who gets Chorioretinitis? (Age and Sex Distribution)

  • Chorioretinitis can affect individuals of any age and gender; both males and females are affected
  • Individuals of different racial and ethnic backgrounds may be affected and no particular preference is noted

What are the Risk Factors for Chorioretinitis? (Predisposing Factors)

The risk factors for Chorioretinitis may include a variety of conditions such as:

  • Individuals with decreased immunity due to a host of conditions such as HIV infection and/or AIDS, cancer or cancer therapy, organ transplantation, and any other debilitating illnesses
  • Increased exposure to bacteria, parasites, viruses, or fungi, due to infections such as:
    • Cytomegalovirus (CMV) infection
    • Herpes simplex virus (HSV) infection
    • Lyme disease
    • Rubella
    • Syphilis
    • Toxocariasis
    • Toxoplasmosis
    • Tuberculosis
    • West Nile virus infection
  • Autoimmune disorders that include the following:
    • Psoriasis
    • Juvenile rheumatoid arthritis (JRA)
    • Systemic lupus erythematosus (SLE)
    • Polyarteritis nodosa
    • Granulomatosis with polyangiitis (GPA)
  • Underlying non-infectious immunologic conditions such as:
    • Behcet’s syndrome
    • Ankylosing spondylitis
    • Sarcoidosis
  • Consuming contaminated food (raw or undercooked meat) and water
  • Exposure to infected pets
  • Participating in activities that have an increased risk for eye injuries
  • Blood vessel inflammation or vasculitis

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Chorioretinitis? (Etiology)

Chorioretinitis is an eye condition that results in inflammation of the choroid and retina.

  • In this condition, the choroid is involved first with presentation of lesions that appear whitish and deep (during a fundoscopic eye exam by a healthcare professional)
  • Since, the choroid is involved first during the initial stages of the condition, no retinal hemorrhages are observed
  • However, as the condition progresses, there is involvement of the retina resulting in retinal hemorrhages during the later stages (with time)

In contrast, the terminology retinochoroiditis indicates that the retina is involved first (with lot of retinal hemorrhages that appear superficial), with subsequent involvement of the choroid. It is important to note that the signs and symptoms due to Chorioretinitis and retinochoroiditis significantly overlap with each other on advancement of both the conditions.

In many, Chorioretinitis is caused by infectious factors; while, in some, it occurs from non-infectious factors. Sometimes, the cause of development of Chorioretinitis remains unknown.

Infectious factors:

  • The most common causes are toxoplasmosis and cytomegalovirus (CMV) infections; these microorganisms are “quite” universal and reportedly found in between 30-50% of the global human populations; however, infections presenting severe symptoms are generally known to manifest in individuals with decreased immune systems
  • Toxoplasmosis and cytomegalovirus can affect a developing fetus during pregnancy; the fetus may get infected transplacentally (via the placenta). In such cases, the baby can develop congenital Chorioretinitis with severe presentations
  • It is reported that almost all cases of congenital toxoplasmosis and nearly 20% of the newborns with congenital cytomegalovirus show Chorioretinitis

Besides the above, the following pathogens are also implicated in the cause of Chorioretinitis:

  • Bacteria that may cause tuberculosis, syphilis, brucellosis, leptospirosis, and Lyme disease
  • Fungi that may cause histoplasmosis (presumed ocular histoplasmosis syndrome)
  • Viruses causing rubella, herpes zoster infection, herpes simplex virus (HSV) infection, and AIDS
  • Parasites causing toxocariasis

Some of the noninfectious causes of Chorioretinitis include the following:

  • A variety of immunologic (autoimmune) conditions such as rheumatoid arthritis (RA), juvenile rheumatoid arthritis (JRA), Reiter’s syndrome (reactive arthritis), systemic lupus erythematosus (SLE), psoriatic arthritis, and psoriasis
  • Inflammatory bowel diseases such as ulcerative colitis
  • Certain allergies
  • Vasculitis or blood vessel inflammation, due to a variety of causes
  • Malignancies such as large cell lymphomas
  • Eye disorders such as acute posterior multifocal placoid pigment epitheliopathy (APMPPE) and birdshot retinochoroidopathy
  • Other conditions include sarcoidosis, Kawasaki disease, multiple sclerosis, Behcet’s syndrome, and ankylosing spondylitis
  • Eye injuries

What are the Signs and Symptoms of Chorioretinitis?

The signs and symptoms of Chorioretinitis may vary between individuals; they may be acute (with sudden onset) or chronic (showing slow onset of signs and symptoms). The signs and symptoms may include:

  • Reduced vision or blurred vision
  • Eye floaters: The individuals experience illusions that some small objects, such as spots, hairs, or strings, are moving in the eye
  • Presence of blind spots, or scotoma, causing partial vision loss
  • Light-sensitivity (photophobia)
  • Impaired color vision
  • Eye pain, in some cases
  • Excessive tearing (flowing of tears)
  • The condition may affect only one eye (unilateral) or both the eyes (bilateral)

Associated presentations of the underlying disorder, condition, or infection causing Chorioretinitis may be observed.

How is Chorioretinitis Diagnosed?

A healthcare professional may diagnose Chorioretinitis using the following tests and procedures:

  • Physical examination and analysis of previous medical history
  • Eye examination by an eye specialist (ophthalmologists or retinal experts)
  • Fundoscopic (ophthalmoscopic) examination by an eye specialist, who examines the back part of the eye (or the fundus); whitish and deep lesions may be observed during the exam 
  • Visual acuity test using a special and standardized test chart (Snellen chart)
  • Slit-lamp examination: Examination of the eye structure using a special instrument called a slit-lamp. In this procedure, the pupils are dilated and the internal eye structure is examined
  • Tonometry: Measurement of intraocular pressure or eye fluid pressure, especially to detect conditions such as glaucoma
  • Fundus fluorescein angiography (FFA): In this technique, the eye blood vessels are examined using a fluorescein dye
  • Fundus autofluorescence (FAF): It is a non-invasive diagnostic technique to examine the fundus of the eye without using a fluorescent dye by a specialized fundus camera 
  • Indocyanine green (ICG) angiography: It is used to examine the blood vessels of the choroid using a dye, called indocyanine green, particularly to study the choroid
  • B-scan ultrasonography: Special ultrasound scan of the eye through a non-invasive diagnostic tool, to assess health of eye structures
  • Electroretinogram (ERG): It is a technique to measure electrical activities in the retinal cells
  • Optical coherence tomography (OCT) of eye: It is an ocular imaging technique to visualize the eye structure
  • Blood tests that include the following:
    • To check for the presence of antibodies in blood
    • Blood culture for infections
    • Complete blood count (CBC) with differential
    • Erythrocyte sedimentation rate (ESR)
  • Tests to determine the underlying condition causing Chorioretinitis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Chorioretinitis?

The complications of Chorioretinitis may include:

  • Glaucoma: A condition that can cause blindness due to higher intraocular pressure
  • Cataracts: When the lens of the eye becomes clouded and cause vision loss
  • Retinal detachment: An eye condition wherein the retina gets separated from the eye structures that holds the retinal layers together
  • Over time and due to a lack of proper treatment, the condition can affect other eye structures such as the lens, optic nerve, and vitreous fluid
  • Vision loss: Chorioretinitis can lead to permanent damage to the eye structure and cause blindness, if left untreated
  • Recurrent Chorioretinitis: The condition may recur if the underlying (infectious) cause is not identified and treated adequately
  • Kidney damage, high blood sugar, and high blood pressure, due to steroid treatment

How is Chorioretinitis Treated?

Early diagnosis and treatment of Chorioretinitis is crucial in preventing complications that may result in irreversible damage to the eye. In general, the management would involve decreasing eye pain and inflammation, addressing the underlying causative condition and associated symptoms, and stopping progression of eye tissue damage with the goal of preserving vision.

Depending on the cause of Chorioretinitis, the treatment can be short-term or long-term. With appropriate treatment, the chance of recurrence (usually from infectious causes) also decreases. The treatment may include the following measures:

  • In case of infection due to toxoplasmosis and cytomegalovirus, treating the infection with appropriate antiparasitic or antiviral medication respectively
  • Use of eye drops and oral medications (including pain medications)
  • Oral corticosteroids to control inflammation; steroids may also be administered intravenously depending on the underlying cause
  • Dark glasses may be prescribed for light-sensitivity
  • Addressing underlying conditions that may be contributing to progression of the disease, which may include other infections, malignancies, autoimmune disorders, or other conditions. This is often very important and forms an inherent part of the treatment plan to successfully resolve Chorioretinitis
  • Administration of immunomodulators, which are medications to control dysfunctional immune system
  • In case of chronic Chorioretinitis that fails to get better with medication, surgery (such as vitrectomy) to treat the condition may be considered

How can Chorioretinitis be Prevented?

It may be difficult to prevent Chorioretinitis, but the risk for the condition may be lowered through the following measures:

  • Avoiding or minimizing contact with individuals who have infections
  • Educating the individual and family members about the underlying cause and preventing the development of any modifiable risk factors associated with the underlying condition (where possible)
  • Treating underlying infections and immunologic conditions, as early as possible
  • Avoid taking raw, undercooked, or improperly cooked meat or vegetables and fruits; only drinking clean water from a reliable and trusted source
  • Washing hands frequently with suitable hand sanitizer
  • Pregnant women have a high-risk of infections (if any) being transmitted to their babies; hence, adequate prenatal care is to be ensured
  • Wearing protective gear (such as industrial goggles or protective glasses) during activities that have an increased risk for eye trauma
  • Maintaining long-term follow-up to watch out for any recurrences

What is the Prognosis of Chorioretinitis? (Outcomes/Resolutions)

  • The prognosis of Chorioretinitis generally varies between individuals. It also depends on the following set of factors:
    • Severity of signs and symptoms and development of any complication(s)
    • Underlying cause of the condition
    • Overall health of the individual
    • Response to treatment
  • Individuals, who do not have severe signs and symptoms, lack ocular complications, and generally respond well to treatment, have a better prognosis
  • Individuals with complications, or those who do not avail adequate treatment, may have a poorer prognosis. Chorioretinitis can result in permanent blindness in some cases

Additional and Relevant Useful Information for Chorioretinitis:

Please visit our Eye & Vision Health Center for more physician-approved health information:

http://www.dovemed.com/health-topics/vision-center/

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Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Oct. 29, 2019
Last updated: March 4, 2020