Neuroretinitis: Update on a visual emergency and role of technology in its diagnosis
Affiliation(s)
Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India. Department of Neurology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India. Department of Neurology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
ABSTRACT
Neuroretinitis is one of the forms of optic neuritis characterized by swelling of optic nerve head and adjoining retinal nerve fiber layer resulting in a macular star configuration. The underlying pathophysiology involves increased permeability of disc vasculature, but the etiology is not fully defined. Neuroretinitis may occur due to an infectious process involving the disc, a postviral or autoimmune mechanism or sometimes idiopathic. Technological advances like ophthalmoscopy, slit-lamp examination, fluorescein angiography, magnetic resonance imaging and immunodiagnostic tests all come handily and are often imperative in making an accurate diagnosis. Conditions mimicking neuroretinitis include papilledema, anterior ischemic optic neuropathy, and infiltration of the optic disc by tumor and systemic hypertension. Neuroretinitis is usually a self-limited disorder with a good visual prognosis. Treatment of neuroretinitis is required only when there is an underlying infectious or inflammatory condition.
Neuroretinitis is one of the forms of optic neuritis characterized by swelling of optic nerve head and adjoining retinal nerve fiber layer resulting in a macular star configuration. The underlying pathophysiology involves increased permeability of disc vasculature, but the etiology is not fully defined. Neuroretinitis may occur due to an infectious process involving the disc, a postviral or autoimmune mechanism or sometimes idiopathic. Technological advances like ophthalmoscopy, slit-lamp examination, fluorescein angiography, magnetic resonance imaging and immunodiagnostic tests all come handily and are often imperative in making an accurate diagnosis. Conditions mimicking neuroretinitis include papilledema, anterior ischemic optic neuropathy, and infiltration of the optic disc by tumor and systemic hypertension. Neuroretinitis is usually a self-limited disorder with a good visual prognosis. Treatment of neuroretinitis is required only when there is an underlying infectious or inflammatory condition.
Cite this paper
Kaliaperumal, S. and Narayan, S. (2013) Neuroretinitis: Update on a visual emergency and role of technology in its diagnosis. Journal of Biomedical Science and Engineering, 6, 15-19. doi: 10.4236/jbise.2013.610A2003.
Kaliaperumal, S. and Narayan, S. (2013) Neuroretinitis: Update on a visual emergency and role of technology in its diagnosis. Journal of Biomedical Science and Engineering, 6, 15-19. doi: 10.4236/jbise.2013.610A2003.
References
[1] Leber T. (1916) Die pseudonephritischen netzhauterkrankungen, die retinitis stellata: Die purtschersche netzhautaffektion nack schwerer schadelverletzung. In: Graefe, A.C. and Saemische, T., Eds., Graefe-Saemisch Handbuch der Augerheilkunde, 2nd Edition, Engelmann, Leipzig, 1319. [2] Gass, J.D.M. (1977) Diseases of the optic nerve that may simulatemacular disease. Transactions American Academy of Ophthalmology and Otolaryngology, 83, 766-769. [3] Maitland, C.G. and Miller, N.R. (1984) Neuroretinitis. Archives of Ophthalmology, 102, 1146-1150.
http://dx.doi.org/10.1001/archopht.1984.01040030924014 [4] Walsh, F.B. and Hoyt, W.F. (1982) Neuroretinitis. In: Clinical Neuro-Ophthalmology, 3rd Edition, Williams & Wilkins Co., Baltimore, 234-235. [5] Glaser, J.S. (1978) Neuro-ophthalmology. Harper & Row Publishers Inc., Hagers-Town, 85. [6] Purvin, V., Sundaram, S. and Kawasaki, A. (2011) Neuroretinitis: Review of literature and new observations. Journal of Neuro-Ophthalmology, 31, 58-68.
http://dx.doi.org/10.1097/WNO.0b013e31820cf78a [7] Fish, R.H., Hoskins, J.C. and Kline, L.B. (1993) Toxoplasmosis neuroretinitis. Ophthalmology, 100, 1177-1182. [8] Purvin, V., Ranson, N. and Kawasaki, A. (2003) Idiopathic recurrent neuroretinitis—Effects of long-term immunosuppression. Archives of Ophthalmology, 121, 65-67.
http://dx.doi.org/10.1001/archopht.121.1.65 [9] Folk, J.C., Weingeist, T.A., Corbett, J.J., Lobes, L.A. and Watzke, R.C. (1983) Syphilitic neuroretinitis. American Journal of Ophthalmology, 95, 480-486. [10] Foster, R.E., Lowder, C.Y., Meisler, D.M., Kosmorsky, G.S. and Baetz-Greenwalt, B. (1990) Mumps neuroretinitis in an adolescent. American Journal of Ophthalmology, 110, 91-93. [11] Fusco, R., Magli, A. and Guacci, P. (1986) Stellate maculopathy due to salmonella typhi: A case report. Ophthalmologica, 192, 154-158.
http://dx.doi.org/10.1159/000309629 [12] Duke-Elder, S. and Dobree, J.H. (1967) Diseases of the retina. In: Duke-Elder, Ed., System of Ophthalmology, Vol. 10, Henry Kimpton, London, 126-127. [13] Bird, A.C., Smith, J.L. and Curtin, V.T. (1983) Nematode optic neuritis. American Journal of Ophthalmology, 95, 480-486. [14] Forooghian, F., Lam, W.C., Hopkins, J. and Dhanda, D. (2005) Bilateral Neuroretinitis with peripapillary serous retinal detachments in a patient with HIV and HBV. Archives of Ophthalmology, 123, 1447-1449.
http://dx.doi.org/10.1001/archopht.123.10.1447 [15] Parmley, V.C., Schiffman, J.S., Maitland, C.G., Miller, N.R., Dreyer, R.F. and Hoyt, W.F. (1987) Does neuroretinitis rule out multiple sclerosis? Archives of Neurology, 44, 1045-1048.
http://dx.doi.org/10.1001/archneur.1987.00520220047015 [16] Williams, K.E. and Johnson, L.N. (2004) Neuroretinitis in patients with multiple sclerosis. Ophthalmology, 111, 335-340.
http://dx.doi.org/10.1016/S0161-6420(03)00663-8 [17] Leavitt, J.A., Pruthi, S. and Morgenstern, B.Z. (1997) Hypertensive retinopathy mimicking neuroretinitis in a twelve-year-old girl. Survey of Ophthalmology, 41, 477-480.
http://dx.doi.org/10.1016/S0039-6257(97)00016-7 [18] Balcer, L.J. (2006) Optic neuritis. New England Journal of Medicine, 354, 1273-1280.
http://dx.doi.org/10.1056/NEJMcp053247 [19] Carithers, H.A. (1985) Cat-scratch disease. An overview based on a study of 1200 patients. American Journal of Diseases of Children, 139, 1124. [20] Golnik, K.C., Marotto, M.E., Fanous, M.M. and Heitter, D. (1994) Ophthalmic manifestations of rochalimaea species. American Journal of Ophthalmology, 118, 145-151. [21] Chrousos, G.A., Drack, A.V., Young, M., Kattah, J. and Sirdofsky, M. (1990) Neuroretinitis in cat-scratch disease. Journal of Clinical Neuro-Ophthalmology, 10, 92-94. [22] Dreyer, R.F., Hopen, G., Gass, J.D.M. and Smith, J.L. (1984) Leber’s idiopathic stellate neuroretinits. Archives of Ophthalmology, 102, 1140-1145.
http://dx.doi.org/10.1001/archopht.1984.01040030918013
[1] Leber T. (1916) Die pseudonephritischen netzhauterkrankungen, die retinitis stellata: Die purtschersche netzhautaffektion nack schwerer schadelverletzung. In: Graefe, A.C. and Saemische, T., Eds., Graefe-Saemisch Handbuch der Augerheilkunde, 2nd Edition, Engelmann, Leipzig, 1319. [2] Gass, J.D.M. (1977) Diseases of the optic nerve that may simulatemacular disease. Transactions American Academy of Ophthalmology and Otolaryngology, 83, 766-769. [3] Maitland, C.G. and Miller, N.R. (1984) Neuroretinitis. Archives of Ophthalmology, 102, 1146-1150.
http://dx.doi.org/10.1001/archopht.1984.01040030924014 [4] Walsh, F.B. and Hoyt, W.F. (1982) Neuroretinitis. In: Clinical Neuro-Ophthalmology, 3rd Edition, Williams & Wilkins Co., Baltimore, 234-235. [5] Glaser, J.S. (1978) Neuro-ophthalmology. Harper & Row Publishers Inc., Hagers-Town, 85. [6] Purvin, V., Sundaram, S. and Kawasaki, A. (2011) Neuroretinitis: Review of literature and new observations. Journal of Neuro-Ophthalmology, 31, 58-68.
http://dx.doi.org/10.1097/WNO.0b013e31820cf78a [7] Fish, R.H., Hoskins, J.C. and Kline, L.B. (1993) Toxoplasmosis neuroretinitis. Ophthalmology, 100, 1177-1182. [8] Purvin, V., Ranson, N. and Kawasaki, A. (2003) Idiopathic recurrent neuroretinitis—Effects of long-term immunosuppression. Archives of Ophthalmology, 121, 65-67.
http://dx.doi.org/10.1001/archopht.121.1.65 [9] Folk, J.C., Weingeist, T.A., Corbett, J.J., Lobes, L.A. and Watzke, R.C. (1983) Syphilitic neuroretinitis. American Journal of Ophthalmology, 95, 480-486. [10] Foster, R.E., Lowder, C.Y., Meisler, D.M., Kosmorsky, G.S. and Baetz-Greenwalt, B. (1990) Mumps neuroretinitis in an adolescent. American Journal of Ophthalmology, 110, 91-93. [11] Fusco, R., Magli, A. and Guacci, P. (1986) Stellate maculopathy due to salmonella typhi: A case report. Ophthalmologica, 192, 154-158.
http://dx.doi.org/10.1159/000309629 [12] Duke-Elder, S. and Dobree, J.H. (1967) Diseases of the retina. In: Duke-Elder, Ed., System of Ophthalmology, Vol. 10, Henry Kimpton, London, 126-127. [13] Bird, A.C., Smith, J.L. and Curtin, V.T. (1983) Nematode optic neuritis. American Journal of Ophthalmology, 95, 480-486. [14] Forooghian, F., Lam, W.C., Hopkins, J. and Dhanda, D. (2005) Bilateral Neuroretinitis with peripapillary serous retinal detachments in a patient with HIV and HBV. Archives of Ophthalmology, 123, 1447-1449.
http://dx.doi.org/10.1001/archopht.123.10.1447 [15] Parmley, V.C., Schiffman, J.S., Maitland, C.G., Miller, N.R., Dreyer, R.F. and Hoyt, W.F. (1987) Does neuroretinitis rule out multiple sclerosis? Archives of Neurology, 44, 1045-1048.
http://dx.doi.org/10.1001/archneur.1987.00520220047015 [16] Williams, K.E. and Johnson, L.N. (2004) Neuroretinitis in patients with multiple sclerosis. Ophthalmology, 111, 335-340.
http://dx.doi.org/10.1016/S0161-6420(03)00663-8 [17] Leavitt, J.A., Pruthi, S. and Morgenstern, B.Z. (1997) Hypertensive retinopathy mimicking neuroretinitis in a twelve-year-old girl. Survey of Ophthalmology, 41, 477-480.
http://dx.doi.org/10.1016/S0039-6257(97)00016-7 [18] Balcer, L.J. (2006) Optic neuritis. New England Journal of Medicine, 354, 1273-1280.
http://dx.doi.org/10.1056/NEJMcp053247 [19] Carithers, H.A. (1985) Cat-scratch disease. An overview based on a study of 1200 patients. American Journal of Diseases of Children, 139, 1124. [20] Golnik, K.C., Marotto, M.E., Fanous, M.M. and Heitter, D. (1994) Ophthalmic manifestations of rochalimaea species. American Journal of Ophthalmology, 118, 145-151. [21] Chrousos, G.A., Drack, A.V., Young, M., Kattah, J. and Sirdofsky, M. (1990) Neuroretinitis in cat-scratch disease. Journal of Clinical Neuro-Ophthalmology, 10, 92-94. [22] Dreyer, R.F., Hopen, G., Gass, J.D.M. and Smith, J.L. (1984) Leber’s idiopathic stellate neuroretinits. Archives of Ophthalmology, 102, 1140-1145.
http://dx.doi.org/10.1001/archopht.1984.01040030918013