"Other major infectious agents, such as B. burgdorferi and Leptospirosis spp.
are known to remain sequestered within the circulatory system."

1: Int Ophthalmol Clin 2001 Winter;41(1):83-102 Related Articles, Books,
LinkOut  
Neuroretinitis.

Ray S, Gragoudas E.

Harvard Medical School, Massachusetts Eye and Ear Infirmary, 243 Charles
Street, Boston, MA 02114, USA.

Despite the growing list of agents that can present as neuroretinitis, nearly
one-half remain idiopathic. However, many of the candidate etiologies are
treatable conditions, and accurate diagnosis can result in visual
rehabilitation. A complete workup in patients presenting with acute
neuroretinitis should include a thorough history and general medical
evaluation. Exposure history should be thoroughly explored, including recent
travel, unpasteurized and uncooked foods, {*filter*} experience, and animal
contacts. A detailed physical examination should be performed to note hidden
rashes and inoculation sites and should include routine measurements of {*filter*}
pressure and heart rate. Laboratory tests should be tailored to the history and
may include complete {*filter*} count; erythrocyte sedimentation rate; bacterial,
fungal, and viral {*filter*} cultures; antinuclear antibody test;
angiotensin-converting enzyme; anti-double-stranded DNA; and C3. Serological
evaluation should look for syphilis, Lyme disease, histoplasmosis, brucellosis,
chlamydia, HIV, toxoplasmosis, Epstein-Barr virus, viral hepatitis B and C, and
tuberculin skin test. Neuroretinitis is a clinical entity in which there is
inflammation of the retinal architecture and optic nerve. There are numerous
entities that can cause a picture of neuroretinitis ranging from vascular to
infectious to autoimmune. With regards to the infectious etiologies, it is
interesting to note that many of these organisms are obligate intracellular
pathogens. The microorganisms B. henselae, T. gondii, R. typhi, T. pallidum,
Mycobacterium tuberculosis, Histoplasma capsulatum, and various viruses, such
as HIV, mumps, and HSV, are known intracellular agents. Other major infectious
agents, such as B. burgdorferi and Leptospirosis spp. are known to remain
sequestered within the circulatory system. It is possible that in this way
these agents are able to breach the delicate {*filter*}-brain barrier. The
implication of such findings on the treatment and management of neuroretinitis
remains to be explored. Interestingly, the vast majority of infected patients
do not develop neuroretinitis or demonstrate CNS involvement. Detailed
examination of this variability may provide further insight into the pathogenic
properties of these infectious agents, host tissue susceptibility, and
mechanisms of {*filter*}-retina barrier integrity. A detailed retinal examination
can provide an unobstructed view of the CNS. Careful inspection of this
delicate interface may reveal subtle findings critical for accurate and rapid
diagnosis of underlying systemic pathology. The varied visual and neurological
symptoms of neuroretinitis attest to the fact that this is a disease of both
the retina and contiguous neuronal elements. Such involvement significantly
elevates the risk to the patient and emphasizes the need for early detection
and prompt treatment.

Publication Types:
Review
Review, tutorial

PMID: 11198149 [PubMed - indexed for MEDLINE]