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Neuroretinitis

Neuroretinitis is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Neuroretinitis is an acute inflammatory condition of the retina defined by optic disc edema and stellate maculopathy.
    • A characteristic pattern of macular exudates surrounds the fovea.
    • Vitreous cells are common.
  • Although many cases remain idiopathic, a broad list of infectious and autoimmune conditions has been associated.
  • Various forms of neuroretinitis include the following:
    • Leber idiopathic stellate neuroretinitis
    • Diffuse unilateral subacute neuroretinitis
    • Idiopathic retinitis
    • Vasculitis
    • Idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN)
    • Recurrent neuroretinitis

Epidemiology

  • No gender predilection
  • Ages have been reported from 8 to 55 years, with an average of 28 years.
  • Epidemiologic data are limited for neuroretinitis.

Incidence
Unknown

Prevalence
Unknown

Etiology and Pathophysiology

  • The underlying pathophysiology involves increased permeability of disc vasculature, but the exact etiology is not fully defined.
    • Autoimmune
    • Infectious
  • Optic disc edema is thought to be from the leakage of vessels within the optic nerve as demonstrated by fluorescein angiography (1).
  • Juxtapapillary leakage may contribute to focal detachment and exudates.
  • Exudates within the outer plexiform layer form the characteristic stellate pattern (2). These exudates get reabsorbed by macrophages.
  • Idiopathic (up to 50% of cases)
  • Various bacterial, viral, protozoal, and parasitic causes have been described or suspected (2).
    • More commonly described are Bartonella henselae, Rickettsia typhi, Mycobacterium tuberculosis, Borrelia burgdorferi, Treponema pallidum, Leptospira spp., Toxoplasma gondii, HIV, herpes simplex virus, herpes zoster virus, Epstein-Barr virus, hepatitis B, hepatitis C, mumps, coxsackie B, Toxocara canis, Histoplasma capsulatum, Brucella spp.
  • Autoimmune conditions include antiphospholipid syndrome and sarcoidosis.

Genetics
No known genetic component

Risk Factors

Varies by underlying etiology

General Prevention

See prevention of underlying etiologies.

Commonly Associated Conditions

  • See the broad list of underlying etiologies.
  • Variations include Leber idiopathic stellate neuroretinitis, diffuse unilateral subacute neuroretinitis (associated with nematode infection), idiopathic retinitis, vasculitis, IRVAN, and recurrent neuroretinitis.

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Citation

Stephens, Mark B., et al., editors. "Neuroretinitis." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816118/all/Neuroretinitis.
Neuroretinitis. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816118/all/Neuroretinitis. Accessed April 18, 2019.
Neuroretinitis. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816118/all/Neuroretinitis
Neuroretinitis [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 18]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816118/all/Neuroretinitis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Neuroretinitis ID - 816118 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816118/all/Neuroretinitis PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -