Progressive outer retinal necrosis: Difference between revisions
Jump to navigation
Jump to search
| Line 13: | Line 13: | ||
==Pathophysiology== | ==Pathophysiology== | ||
===Pathogenesis=== | |||
*The pathogenesis of Progressive outer retinal necrosis is characterized by [[retinal]] [[inflammation]] due to ocular [[viral]] infection from [[Varicella zoster virus]].<ref name="MoorthyWeinberg1997">{{cite journal|last1=Moorthy|first1=R. S|last2=Weinberg|first2=D. V|last3=Teich|first3=S. A|last4=Berger|first4=B. B|last5=Minturn|first5=J. T|last6=Kumar|first6=S.|last7=Rao|first7=N. A|last8=Fowell|first8=S. M|last9=Loose|first9=I. A|last10=Jampol|first10=L. M|title=Management of varicella zoster virus retinitis in AIDS|journal=British Journal of Ophthalmology|volume=81|issue=3|year=1997|pages=189–194|issn=0007-1161|doi=10.1136/bjo.81.3.189}}</ref> | |||
*Particles from [Varicella zoster]] virus (VZV) infiltrate the [[retina]] via various modes of transmission:<ref name="pmid22889540">{{cite journal |vauthors=Grose C |title=Acute retinal necrosis caused by herpes simplex virus type 2 in children: reactivation of an undiagnosed latent neonatal herpes infection |journal=Semin Pediatr Neurol |volume=19 |issue=3 |pages=115–8 |year=2012 |pmid=22889540 |pmc=3419358 |doi=10.1016/j.spen.2012.02.005 |url=}}</ref> | |||
**[[Epithelial]] penetration of the skin: transmitted through the [[Ophthalmic nerve|ophthalmic]] branch of the [[Trigeminal nerve]]. | |||
**[[Epithelial]] penetration of the [[conjunctiva]]: transmitted directly through the [[optic nerve]]. | |||
**[[Epithelial]] penetration of the [[cornea]]: transmitted through the [[Maxillary|maxillary]] branch of the [[Trigeminal nerve]]. | |||
**[[Epithelial]] penetration of the [[nasal cavity]]: transmitted through the [[Olfactory nerve]] in the [[Subarachnoid space]]. | |||
*[[Retinal]] [[inflammation]] is caused by the up-regulated production of [[cytokines]]. | |||
===Associated Conditions=== | |||
*Progressive outer retinal necrosis is associated with the following ocular conditions: | |||
**[[Acute retinal necrosis]]<ref name="pmid22889540">{{cite journal |vauthors=Grose C |title=Acute retinal necrosis caused by herpes simplex virus type 2 in children: reactivation of an undiagnosed latent neonatal herpes infection |journal=Semin Pediatr Neurol |volume=19 |issue=3 |pages=115–8 |year=2012 |pmid=22889540 |pmc=3419358 |doi=10.1016/j.spen.2012.02.005 |url=}}</ref> | |||
**[[Uveitis]]<ref name="urlFacts About Uveitis | National Eye Institute">{{cite web |url=https://nei.nih.gov/health/uveitis/uveitis |title=Facts About Uveitis | National Eye Institute |format= |work= |accessdate=}}</ref> | |||
**[[Cytomegalovirus retinitis]]<ref name="urlCMV retinitis: MedlinePlus Medical Encyclopedia">{{cite web |url=https://medlineplus.gov/ency/article/000665.htm |title=CMV retinitis: MedlinePlus Medical Encyclopedia |format= |work= |accessdate=}}</ref> | |||
**[[Toxoplasmic chorioretinitis]]<ref name="pmid22116459">{{cite journal |vauthors=Davis JL |title=Diagnostic dilemmas in retinitis and endophthalmitis |journal=Eye (Lond) |volume=26 |issue=2 |pages=194–201 |year=2012 |pmid=22116459 |pmc=3272204 |doi=10.1038/eye.2011.299 |url=}}</ref> | |||
**[[Endophthalmitis]] | |||
==Causes== | ==Causes== | ||
Revision as of 13:15, 30 August 2016
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.
Overview
Progressive outer retinal necrosis (PORN), also known as Varicella zoster virus retinitis (VZVR)[1], is an aggressive, necrotizing inflammation of the eye's retina caused by herpes varicella zoster virus. It is typically found in people with advanced AIDS, but has also been reported in those who are severely immunocompromised due to chemotherapy[2].
The majority of those with progressive outer retinal necrosis develop severe vision loss and blindness[3]. Systemic antiviral drugs may improve the long-term visual outcome in those with the disease[1].
Historical Perspective
Classification
Pathophysiology
Pathogenesis
- The pathogenesis of Progressive outer retinal necrosis is characterized by retinal inflammation due to ocular viral infection from Varicella zoster virus.[4]
- Particles from [Varicella zoster]] virus (VZV) infiltrate the retina via various modes of transmission:[5]
- Epithelial penetration of the skin: transmitted through the ophthalmic branch of the Trigeminal nerve.
- Epithelial penetration of the conjunctiva: transmitted directly through the optic nerve.
- Epithelial penetration of the cornea: transmitted through the maxillary branch of the Trigeminal nerve.
- Epithelial penetration of the nasal cavity: transmitted through the Olfactory nerve in the Subarachnoid space.
- Retinal inflammation is caused by the up-regulated production of cytokines.
Associated Conditions
- Progressive outer retinal necrosis is associated with the following ocular conditions:
Causes
- Progressive outer retinal necrosis (PORN) is primarily caused by Varicella zoster virus (VZV).
- PORN usually results from immunocompromised individuals infected with VZV, usually as a complication of diseases such as AIDS.[9]
Differentiating Progressive outer retinal necrosis from Other Diseases
- Progressive outer retinal necrosis (PORN) must be differentiated from other diseases that cause eye pain, conjunctival infection, photophobia, and vision loss. Accurate and prompt diagnosis is critical to prevent blindness and complications.[8][10][11][12]
- PORN is differentiated from Acute retinal necrosis by its occurrence primarily in immunocompromised individuals; Acute retinal necrosis will also develop in immunocompetent individuals.
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications, and Prognosis
Natural History
Complications
Prognosis
Diagnosis
Diagnostic Criteria
The following standardized criteria are used to officially diagnose Progessive outer retinal necrosis:[9]
- Presence of multifocal lesions without granular borders in the deep retinal layers
- Evidence that the infection started in the peripheral retina with or without focal involvement
- Extremely rapid progression
- Presence of minimal intraocular infection
History and Symptoms
History
Symptoms
Symptoms of Progressive outer retinal necrosis include the following:[9]
Physical Examination
Physical examination for Progressive outer retinal necrosis may be remarkable for the following:
- White-yellow necrotic retinal [[lesions], coalescing in the anterior chamber[4]
- Opaque
Laboratory Findings
Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Prevention
See also
- Cytomegalovirus retinitis
- List of eye diseases and disorders
- List of systemic diseases with ocular manifestations
References
- ↑ 1.0 1.1 Moorthy RS, Weinberg DV, Teich SA, Berger BB, Minturn JT, Kumar S, Rao NA, Fowell SM, Loose IA, Jampol LM. "Management of varicella zoster virus retinitis in AIDS." Br J Ophthalmol. 1997 Mar;81(3):189-94. PMID 9135381
- ↑ Copeland R, Phillpotts B. "Ocular Manifestations of HIV." eMedicine.com. January 20, 2005.
- ↑ Holland GN. "The progressive outer retinal necrosis syndrome." Int Ophthalmol. 1994;18(3):163-5. PMID 7852023.
- ↑ 4.0 4.1 4.2 Moorthy, R. S; Weinberg, D. V; Teich, S. A; Berger, B. B; Minturn, J. T; Kumar, S.; Rao, N. A; Fowell, S. M; Loose, I. A; Jampol, L. M (1997). "Management of varicella zoster virus retinitis in AIDS". British Journal of Ophthalmology. 81 (3): 189–194. doi:10.1136/bjo.81.3.189. ISSN 0007-1161.
- ↑ 5.0 5.1 Grose C (2012). "Acute retinal necrosis caused by herpes simplex virus type 2 in children: reactivation of an undiagnosed latent neonatal herpes infection". Semin Pediatr Neurol. 19 (3): 115–8. doi:10.1016/j.spen.2012.02.005. PMC 3419358. PMID 22889540.
- ↑ 6.0 6.1 6.2 "Facts About Uveitis | National Eye Institute".
- ↑ 7.0 7.1 "CMV retinitis: MedlinePlus Medical Encyclopedia".
- ↑ 8.0 8.1 8.2 Davis JL (2012). "Diagnostic dilemmas in retinitis and endophthalmitis". Eye (Lond). 26 (2): 194–201. doi:10.1038/eye.2011.299. PMC 3272204. PMID 22116459.
- ↑ 9.0 9.1 9.2 Engstrom RE, Holland GN, Margolis TP, Muccioli C, Lindley JI, Belfort R, Holland SP, Johnston WH, Wolitz RA, Kreiger AE (1994). "The progressive outer retinal necrosis syndrome. A variant of necrotizing herpetic retinopathy in patients with AIDS". Ophthalmology. 101 (9): 1488–502. PMID 8090452.
- ↑ Dart JK (1986). "Eye disease at a community health centre". Br Med J (Clin Res Ed). 293 (6560): 1477–80. PMC 1342247. PMID 3099921.
- ↑ Leibowitz HM (2000). "The red eye". N Engl J Med. 343 (5): 345–51. doi:10.1056/NEJM200008033430507. PMID 10922425.
- ↑ University of Michigan Eyes Have it (2009)http://kellogg.umich.edu/theeyeshaveit/red-eye/
- ↑ Abu El-Asrar AM, Herbort CP, Tabbara KF (2009). "Differential diagnosis of retinal vasculitis". Middle East Afr J Ophthalmol. 16 (4): 202–18. doi:10.4103/0974-9233.58423. PMC 2855661. PMID 20404987.