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==Overview==
==Overview==


As retinitis manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. Retinitis caused by genetic defects such as retinitis pigmentosa must be differentiated from other diseases that cause visual acuity, cone-rod dystrophy, night blindness, and vision loss. Infectious agents that cause retinitis must be differentiated from other ocular diseases that may cause lesions and retinal scarring.
As retinitis manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. Retinitis caused by [[genetic defects]] such as retinitis pigmentosa must be differentiated from other diseases that cause [[visual acuity]], [[cone-rod dystrophy]], [[Nyctalopia|night blindness]], and [[vision loss]]. [[Infectious agents]] that cause retinitis must be differentiated from other ocular diseases that may cause lesions and retinal scarring.


==Differential Diagnosis==
==Differential Diagnosis==
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | Usher syndrome  
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Usher syndrome  
| style="background: #DCDCDC; padding: 5px;" |  
| style="background: #DCDCDC; padding: 5px;" |  
*'''Usher syndrome''' is a relatively rare [[genetic disorder]] that is associated with a mutation in any one of 10 [[gene]]s. .<ref name="mets_2000" >{{cite journal | author = Mets MB, Young NM, Pass A, Lasky JB | date = 2000 | title = Early diagnosis of Usher syndrome in children | journal = Transactions of the American Ophthalmological Society | volume = 98 | pages = 237&ndash;245 | pmid = 11190026}}</ref>  Usher syndrome is incurable at present; however, using [[gene therapy]] to replace the missing gene, researchers have succeeded in reversing one form of the disease in [[knockout mouse|knockout mice
*'''Usher syndrome''' is a relatively rare [[genetic disorder]] that is associated with a mutation in any one of 10 [[gene]]s. .<ref name="mets_2000">{{cite journal | author = Mets MB, Young NM, Pass A, Lasky JB | date = 2000 | title = Early diagnosis of Usher syndrome in children | journal = Transactions of the American Ophthalmological Society | volume = 98 | pages = 237&ndash;245 | pmid = 11190026}}</ref>  Usher syndrome is incurable at present; however, using [[gene therapy]] to replace the missing gene, researchers have succeeded in reversing one form of the disease in [[knockout mouse|knockout mice
*Vision loss is commonly associated with [[retinitis pigmentosa]] (rp), a degeneration of the retinal cells.   
*Vision loss is commonly associated with [[retinitis pigmentosa]] (rp), a degeneration of the retinal cells.   
*The [[rod cell]]s of the [[retina]] are affected first, leading to early [[night blindness]] and the gradual loss of [[peripheral vision]].   
*The [[rod cell]]s of the [[retina]] are affected first, leading to early [[night blindness]] and the gradual loss of [[peripheral vision]].   
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| style="background: #DCDCDC; padding: 5px;" |   
| style="background: #DCDCDC; padding: 5px;" |   
*'''Leber's congenital amaurosis''' ('''LCA''') is a rare [[heredity|inherited]] [[List of eye diseases and disorders|eye disease]] that appears at [[congenital|birth]] or in the first few months of life, and affects around 1 in 80,000 of the population.<ref>{{cite journal | author= Stone EM | title= Leber congenital amaurosis — a model for efficient genetic testing of heterogeneous disorders: LXIV Edward Jackson Memorial Lecture | journal= Am J Ophthalmol | volume = 144 | issue = 6 | pages = 791–811 |date=December 2007 |pmid=17964524 |doi=10.1016/j.ajo.2007.08.022 |url=http://www.ajo.com/article/PIIS0002939407007672/}}</ref>  
*'''Leber's congenital amaurosis''' ('''LCA''') is a rare [[heredity|inherited]] [[List of eye diseases and disorders|eye disease]] that appears at [[congenital|birth]] or in the first few months of life, and affects around 1 in 80,000 of the population.<ref>{{cite journal | author= Stone EM | title= Leber congenital amaurosis — a model for efficient genetic testing of heterogeneous disorders: LXIV Edward Jackson Memorial Lecture | journal= Am J Ophthalmol | volume = 144 | issue = 6 | pages = 791–811 |date=December 2007 |pmid=17964524 |doi=10.1016/j.ajo.2007.08.022 |url=http://www.ajo.com/article/PIIS0002939407007672/}}</ref>  
*LCA is typically characterized by [[pathologic nystagmus|nystagmus]], sluggish or absent [[Pupillary reflex|pupillary responses]],<ref name="GR">{{cite journal | pmid=20301475 | journal=GeneReviews | title= Leber Congenital Amaurosis. |author=Weleber RG, Francis PJ, Trzupek KM, Beattie C.}}</ref> and severe [[vision loss]] or [[blindness]].<ref name="OMIMLCA" />
*LCA is typically characterized by [[pathologic nystagmus|nystagmus]], sluggish or absent [[Pupillary reflex|pupillary responses]],<ref name="GR">{{cite journal | pmid=20301475 | journal=GeneReviews | title= Leber Congenital Amaurosis. |author=Weleber RG, Francis PJ, Trzupek KM, Beattie C.}}</ref> and severe [[vision loss]] or [[blindness]].
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Bardet-Biedl syndrome
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Bardet-Biedl syndrome
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | Cytomegalovirus
| style="background: #F5F5F5; padding: 5px; text-align: center;" | Cytomegalovirus
| style="background: #DCDCDC; padding: 5px;" |  
| style="background: #DCDCDC; padding: 5px;" |  
*Physical evidence of a cytomegalovirus presence in one of both eyes will generally clinical present in the form of lesions, adjacent retinal vessels.  
*Physical evidence of a [[Cytomegalovirus (patient information)|cytomegalovirus]] presence in one of both eyes will generally clinical present in the form of [[lesions]], adjacent retinal vessels.  
*These lesions may impinge upon the fovea and the optic nerve. Furthermore they are usually discovered in close proximity to both.  
*These [[lesions]] may impinge upon the [[fovea]] and the [[optic nerve]]. Furthermore they are usually discovered in close proximity to both.  
*Further extending legions may be present in close proximity to the vortex veins as well as the ora serrata.<ref name="ret phys">Infectious Retinitis: A Review. YACHNA AHUJA, MD · STEVEN M. COUCH, MD · RAYMUND R. RAZONABLE, MD · SOPHIE J. BAKRI, MD. http://www.retinalphysician.com/articleviewer.aspx?articleID=102293. Accessed April 13, 2016. </ref>
*Further extending lesions may be present in close proximity to the vortex veins as well as the [[ora serrata]].<ref name="ret phys">Infectious Retinitis: A Review. YACHNA AHUJA, MD · STEVEN M. COUCH, MD · RAYMUND R. RAZONABLE, MD · SOPHIE J. BAKRI, MD. http://www.retinalphysician.com/articleviewer.aspx?articleID=102293. Accessed April 13, 2016. </ref>
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Tuberculosis
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Tuberculosis
| style="background: #DCDCDC; padding: 5px;" |   
| style="background: #DCDCDC; padding: 5px;" |   
*Caseating granulomas
*Caseating [[Granuloma|granulomas]]
*Multiple choroidal tubercles- small grayish nodules located on the posterior pole of the eye
*Multiple [[choroidal]] tubercles- small grayish nodules located on the posterior pole of the eye
*Yellow necrotizing granulomas<ref name="ret phys">Infectious Retinitis: A Review. YACHNA AHUJA, MD · STEVEN M. COUCH, MD · RAYMUND R. RAZONABLE, MD · SOPHIE J. BAKRI, MD. http://www.retinalphysician.com/articleviewer.aspx?articleID=102293. Accessed April 13, 2016. </ref>|-
*Yellow [[necrotizing]] [[granulomas]]<ref name="ret phys">Infectious Retinitis: A Review. YACHNA AHUJA, MD · STEVEN M. COUCH, MD · RAYMUND R. RAZONABLE, MD · SOPHIE J. BAKRI, MD. http://www.retinalphysician.com/articleviewer.aspx?articleID=102293. Accessed April 13, 2016. </ref>|
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Fungal
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Fungal
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====''Candida albicans''====
====''Candida albicans''====
*Visibly hazy vitreous
*Visibly hazy [[Vitreous floaters|vitreous]]
*White circumscribed lesions<ref name="ret phys">Infectious Retinitis: A Review. YACHNA AHUJA, MD · STEVEN M. COUCH, MD · RAYMUND R. RAZONABLE, MD · SOPHIE J. BAKRI, MD. http://www.retinalphysician.com/articleviewer.aspx?articleID=102293. Accessed April 13, 2016. </ref>
*White circumscribed [[lesions]]<ref name="ret phys">Infectious Retinitis: A Review. YACHNA AHUJA, MD · STEVEN M. COUCH, MD · RAYMUND R. RAZONABLE, MD · SOPHIE J. BAKRI, MD. http://www.retinalphysician.com/articleviewer.aspx?articleID=102293. Accessed April 13, 2016. </ref>


====''Aspergillus fumigatus''====
====''Aspergillus fumigatus''====
*Yellow subretinal infiltrates  
*Yellow subretinal infiltrates  
*Retinal infiltrates  
*Retinal infiltrates  
*Fungal hyphae are located throughout the eye - suggestive of pulmonary involvement<ref name="ret phys">Infectious Retinitis: A Review. YACHNA AHUJA, MD · STEVEN M. COUCH, MD · RAYMUND R. RAZONABLE, MD · SOPHIE J. BAKRI, MD. http://www.retinalphysician.com/articleviewer.aspx?articleID=102293. Accessed April 13, 2016. </ref>
*Fungal [[hyphae]] are located throughout the eye - suggestive of pulmonary involvement<ref name="ret phys">Infectious Retinitis: A Review. YACHNA AHUJA, MD · STEVEN M. COUCH, MD · RAYMUND R. RAZONABLE, MD · SOPHIE J. BAKRI, MD. http://www.retinalphysician.com/articleviewer.aspx?articleID=102293. Accessed April 13, 2016. </ref>


====''Cryptococcus neoformans''====
====''Cryptococcus neoformans''====
*Yellowish-white lesions located on the fundus of the eye
*Yellowish-white lesions located on the [[fundus]] of the eye
*Mutton-fat keratic precipitates<ref name="ret phys">Infectious Retinitis: A Review. YACHNA AHUJA, MD · STEVEN M. COUCH, MD · RAYMUND R. RAZONABLE, MD · SOPHIE J. BAKRI, MD. http://www.retinalphysician.com/articleviewer.aspx?articleID=102293. Accessed April 13, 2016. </ref>
*Mutton-fat keratic [[precipitates]]<ref name="ret phys">Infectious Retinitis: A Review. YACHNA AHUJA, MD · STEVEN M. COUCH, MD · RAYMUND R. RAZONABLE, MD · SOPHIE J. BAKRI, MD. http://www.retinalphysician.com/articleviewer.aspx?articleID=102293. Accessed April 13, 2016. </ref>
|-
|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Toxoplasmosis
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Toxoplasmosis
| style="background: #DCDCDC; padding: 5px;" |  
| style="background: #DCDCDC; padding: 5px;" |  
*Localized areas of infiltrate
*Localized areas of infiltrate
*Active lesions are adjacent to initial scarring<ref name="ret phys">Infectious Retinitis: A Review. YACHNA AHUJA, MD · STEVEN M. COUCH, MD · RAYMUND R. RAZONABLE, MD · SOPHIE J. BAKRI, MD. http://www.retinalphysician.com/articleviewer.aspx?articleID=102293. Accessed April 13, 2016. </ref>
*Active [[lesions]] are adjacent to initial scarring<ref name="ret phys">Infectious Retinitis: A Review. YACHNA AHUJA, MD · STEVEN M. COUCH, MD · RAYMUND R. RAZONABLE, MD · SOPHIE J. BAKRI, MD. http://www.retinalphysician.com/articleviewer.aspx?articleID=102293. Accessed April 13, 2016. </ref>


|-  
|-  
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Syphilis
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Syphilis
| style="background: #DCDCDC; padding: 5px;" |  
| style="background: #DCDCDC; padding: 5px;" |  
*Hemorrhagic areas
*[[Hemorrhagic]] areas
*Flare visible in anterior and posterior portions<ref name="ret phys">Infectious Retinitis: A Review. YACHNA AHUJA, MD · STEVEN M. COUCH, MD · RAYMUND R. RAZONABLE, MD · SOPHIE J. BAKRI, MD. http://www.retinalphysician.com/articleviewer.aspx?articleID=102293. Accessed April 13, 2016. </ref>
*Flare visible in anterior and posterior portions<ref name="ret phys">Infectious Retinitis: A Review. YACHNA AHUJA, MD · STEVEN M. COUCH, MD · RAYMUND R. RAZONABLE, MD · SOPHIE J. BAKRI, MD. http://www.retinalphysician.com/articleviewer.aspx?articleID=102293. Accessed April 13, 2016. </ref>
|-  
|-  
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[[Category:Disease]]
[[Category:Disease]]
[[Category:Ophthalmology]]
[[Category:Ophthalmology]]
[[Category:Infectious disease]]
 


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Latest revision as of 18:36, 18 September 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Ilan Dock, B.S.

Overview

As retinitis manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. Retinitis caused by genetic defects such as retinitis pigmentosa must be differentiated from other diseases that cause visual acuity, cone-rod dystrophy, night blindness, and vision loss. Infectious agents that cause retinitis must be differentiated from other ocular diseases that may cause lesions and retinal scarring.

Differential Diagnosis

Genetic Disorders

Disease Definition
Usher syndrome
  • Usher syndrome is a relatively rare genetic disorder that is associated with a mutation in any one of 10 genes. .[1] Usher syndrome is incurable at present; however, using gene therapy to replace the missing gene, researchers have succeeded in reversing one form of the disease in [[knockout mouse|knockout mice
  • Vision loss is commonly associated with retinitis pigmentosa (rp), a degeneration of the retinal cells.
  • The rod cells of the retina are affected first, leading to early night blindness and the gradual loss of peripheral vision.
  • There is often early degeneration of the cone cells in the macula, leading to a loss of central acuity. In some cases, the foveal vision is spared, leading to "doughnut vision"; central and peripheral vision are intact, but there is an annulus around the central region in which vision is impaired.
Leber congenital amaurosis (LCA)
Bardet-Biedl syndrome
Cone and cone-rod dystrophy
  • A cone dystrophy is an inherited ocular disorder characterized by the loss of cone cells, the photoreceptors responsible for both central and color vision.
  • The most common symptoms of cone dystrophy are vision loss (age of onset ranging from the late teens to the sixties), sensitivity to bright lights, and poor color vision. Therefore, patients see better at dusk and have progressive difficulty with daytime vision.
  • Visual acuity usually deteriorates gradually, but it can deteriorate rapidly to 20/200; later, in more severe cases, it drops to counting fingers vision.
  • Color vision testing using color test plates (HRR series) reveals many errors on both red-green and blue-yellow plates.
Choroideremia
  • Choroideremia is an X-linked recessive retinal degenerative disease that leads to the degeneration of the choriocapillaris, the retinal pigment epithelium, and the photoreceptor of the eye.
  • Choroideremia is caused by the deletion of the Rab escort protein 1 (REP1).
  • Choroideremia has been associated with night blindness in youth.
  • As the disease progresses, a CHM sufferer loses their peripheral vision and depth perception, eventually losing all sight by middle age.

Infectious Agents

Infectious Agent Clinical Manifestations
Cytomegalovirus
  • Physical evidence of a cytomegalovirus presence in one of both eyes will generally clinical present in the form of lesions, adjacent retinal vessels.
  • These lesions may impinge upon the fovea and the optic nerve. Furthermore they are usually discovered in close proximity to both.
  • Further extending lesions may be present in close proximity to the vortex veins as well as the ora serrata.[7]
Tuberculosis
Fungal

Candida albicans

Aspergillus fumigatus

  • Yellow subretinal infiltrates
  • Retinal infiltrates
  • Fungal hyphae are located throughout the eye - suggestive of pulmonary involvement[7]

Cryptococcus neoformans

Toxoplasmosis
  • Localized areas of infiltrate
  • Active lesions are adjacent to initial scarring[7]
Syphilis

References

  1. ↑ Mets MB, Young NM, Pass A, Lasky JB (2000). "Early diagnosis of Usher syndrome in children". Transactions of the American Ophthalmological Society. 98: 237&ndash, 245. PMID 11190026.
  2. ↑ Stone EM (December 2007). "Leber congenital amaurosis — a model for efficient genetic testing of heterogeneous disorders: LXIV Edward Jackson Memorial Lecture". Am J Ophthalmol. 144 (6): 791–811. doi:10.1016/j.ajo.2007.08.022. PMID 17964524.
  3. ↑ Weleber RG, Francis PJ, Trzupek KM, Beattie C. "Leber Congenital Amaurosis". GeneReviews. PMID 20301475.
  4. ↑ Beales P, Elcioglu N, Woolf A, Parker D, Flinter F (1999). "New criteria for improved diagnosis of Bardet-Biedl syndrome: results of a population survey". J. Med. Genet. 36 (6): 437–46. PMID 10874630.
  5. ↑ Ansley SJ, Badano JL, Blacque OE, Hill J, Hoskins BE, Leitch CC, Kim JC, Ross AJ, Eichers ER, Teslovich TM, Mah AK, Johnsen RC, Cavender JC, Lewis RA, Leroux MR, Beales PL, Katsanis N (2003). "Basal body dysfunction is a likely cause of pleiotropic Bardet–Biedl syndrome". Nature. 425 (6958): 628–33. doi:10.1038/nature02030. PMID 14520415. Unknown parameter |month= ignored (help)
  6. ↑ Moore SJ, Green JS, Fan Y; et al. (2005). "Clinical and genetic epidemiology of Bardet-Biedl syndrome in Newfoundland: a 22-year prospective, population-based, cohort study". American Journal of Medical Genetics. Part a. 132 (4): 352–60. doi:10.1002/ajmg.a.30406. PMC 3295827. PMID 15637713. Unknown parameter |month= ignored (help)
  7. ↑ 7.0 7.1 7.2 7.3 7.4 7.5 7.6 Infectious Retinitis: A Review. YACHNA AHUJA, MD · STEVEN M. COUCH, MD · RAYMUND R. RAZONABLE, MD · SOPHIE J. BAKRI, MD. http://www.retinalphysician.com/articleviewer.aspx?articleID=102293. Accessed April 13, 2016.


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