Retinal Vasculitis Explained

Retinal Vasculitis

Introduction

The retina is a part of the eyes critical for vision. The cornea and lens bring light into focus at the retina, where an image is formed; this image is transformed into nerve impulses and sent to the brain. The retina is supplied by small vessels. As the name indicates, retinal vasculitis is inflammation of the retinal vessels that can happen due to a variety of causes e.g infections or autoimmune processes. Retinal vasculitis may occur as an isolated disease or as a complication of an underlying disease. Irreversible damage to vision or blindness occurs in most cases.

Retinal vasculitis can occur in any age group without gender discrimination. However, most patients with isolated retinal vasculitis are young adults without prior disease history. The classification of retinal vasculitis is based on the involvement of an artery or vein, and its staging is done based on the extent of disease involvement e.g initial stage, tortuous vessels, and growth of new retinal vessels.

What Are The Symptoms Of Retinal Vasculitis? 1,2

Patients with retinal vasculitis often present with one or more of the following complaints:

• Flashes of light

• Small abnormal shapes coming into your vision

• Visual distortion (straight lines becoming wavy)

• Burning sensation 

• Eye pain

• Formation of the blind spots in the visual area that may enlarge with time

What Are The Causes Of Retinal Vasculitis? 1,2

Inflammation of small vessels results in narrowing and decreased blood supply to the retina. This stimulates the formation of new fragile blood vessels. These newly formed vessels are easily damaged and increase the disease burden. 

Retinal vasculitis occurs in the background of other conditions, usually as a part of an ocular or systemic disease. As mentioned above, it may also be an isolated or idiopathic condition. It is more common in individuals older than 40 years old. 

1. Infectious causes

1. The cause may be bacterial, viral, or fungal including:

1. Tuberculosis 

2. Syphilis

3. Lyme disease

4. Brucellosis

5. Endophthalmitis

6. Candidiasis

7. Toxoplasmosis

2. Noninfectious causes

1. These include a variety of causes including ocular and systemic diseases, including: 

1. Eales disease

2. Chorioretinopathy

3. Sarcoidosis

4. Systemic lupus erythematosus

5. Behcet disease

6. Crohn's disease

7. Rheumatoid arthritis 

8. Multiple sclerosis 

9. Leukemia

10. Lymphoma

How Is Retinal Vasculitis Diagnosed? 1,2

An ophthalmologist diagnoses retinal vasculitis via the following steps:

• History and physical examination

• Clinical signs of retinal vasculitis

• Slit lamp examination

• Imaging tests

• Fluorescein angiography 

• Ultrasonography

• Optical coherence tomography CT scan

• MRI of multiple systems 

• Radiography

• Radio nucleotide scanning

• Laboratory investigations

• Complete blood profile 

• Inflammatory factors

• Liver function tests

• Kidney function tests

• Skin tuberculin test

• Complete serology to rule out infectious agents

• Serum autoantibodies to rule out autoimmune causes

• HLA and genetic testing may be required in idiopathic retinal vasculitis cases

How Is Retinal Vasculitis Treated? 3

The treatment of retinal vasculitis is directed against the source of infection or autoimmune condition. An early diagnosis of retinal vasculitis is crucial to reduce damage to vision and ensure a good prognosis.  The main goal of treatment is to control the inflammation with medical management. 

• In mild conditions, local therapy with steroid injections may be sufficient, but most cases require intravenous medications. 

• Steroids are the mainstay of treatment in autoimmune causes or noninfectious causes. 

• Retinal vasculitis recurrence is possible, therefore, aggressive immunosuppression is often required

• Infectious retinal vasculitis requires antibiotics and appropriate interventions

These patients require regular monitoring to assess the stage, severity, and stability of the disease. The ophthalmologist will order imaging tests and blood tests to evaluate vascular wall damage. 

Prognosis

The prognosis of retinal vasculitis is variable depending on the stage at presentation and the underlying cause of the disease. Vision loss can occur especially when the central retina is involved. It is critical to contact your eye doctor immediately should you have any symptoms of retinal vasculitis. 

References

1. Retinal Vasculitis - EyeWiki. (2022, September 17). Retrieved October 15, 2022, from https://eyewiki.aao.org/Retinal_Vasculitis

2. NCBI - WWW Error Blocked Diagnostic. (n.d.). Retrieved October 15, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4893321/

3. NCBI - WWW Error Blocked Diagnostic. (n.d.-b). Retrieved October 15, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK560520/

Author

Eye Surgeons Associates Drs. Zuhair H. Peracha, Manal H. Peracha-Riyaz, Eric Zuckerman, Matthew Pieters, and Leila Siblani are dedicated to excellence in eye care and service. We utilize the latest treatment methods and procedures, including routine eye care, cataract surgery, glaucoma treatment, retinal disease management, diabetic eye treatment, and eyelid surgery.