Retinal vasculitis
To define the case as retinal vasculitis you should have the following findings in Retinal vasculitis
1)vitreous cells (if absent with exudates along vessels consider; diabetic retinopathy, Vein occlusion, adult Coat’s, radiation or sickle cell)
2)perivascular infiltrate or sheathing in more than one vessel
3)FFA evidence of vascular leakage and/or occlusion
4)absence of multifocal choroiditis
The next step is to look for evidence of systemic manifestations or lab changes mainly in Retinal vasculitis
1)fever, malaise
2)arthritis
3)rash
4)CBC
5)ESR, CRP
If No systemic manifestations and negative screening labs (no need for expensive labs in these cases) in Retinal vasculitis
1)child—-frosted branch angiitis
2)20-40—-pars planitis, acute retinal necrosis, Eale’s
4)40’s—- birdshot, autoimmune vasculitis
5)50’s—intraocular lymphoma
If there are systemic manifestations and positive screening labs, think of and do investigations accordingly; in Retinal vasculitis
1)Child; exanthemata, leukemia, Kawasaki
2)20-40 male; Behçet’s, Sarcoidosis, TB, HIV/CMV, Syphilis
3)female; SLE and other collagen, sarcoidosis, TB, MS
4)above 60; temporal arteritis, lymphoma
5)Immunocompromised; HIV/CMV, Syphilis, Toxoplasmosis, Systemic leukemia or lymphoma, Systemic candidiasis
6)Rare; Lyme’s, Whipple’s, Wegener’s
Retinal Vasculitis videos :
Retinal Vasculitis – YouTube
Author: Akbar Shakoor, MD, Assistant Professor (Clinical)
Road-to-Wellness Webinar: Vasculitis and the Eye vasculitis foundation.
Retinitis and retinal vasculitis – YouTube
Retinitis and retinal vasculitis 2 – YouTube
Retinal vasculitis power point presentations :
Retinal vasculitis by Dr.Yousaf Jamal
Retinal vasculitis is a sight threatening inflammatory eye disease affecting the retinal vasculature. • Presents as: a. Periphlebitis: veins are affected b. Periarteritis: arteries are affected or c. Angiitis: as a combination of both
- SYMPTOMS • Asymptomatic if restricted to peripheral fundus • Gradual, painless loss of vision (most common) • Floaters (indicates significant migration of leukocytes to vitreous) • Photopsia & reduced color vision (less common but present in vasculitis surrounding macula) • Central or Para central scotomata
- SIGNS • RAPD in M.S. • Visual field defects • Abnormal Amsler grid & color vision • Elevated IOP in ocular toxoplasmosis • A/C cells & Flare • Neovasularization • Vitrits • Vitreous hemorrhages
- PRIMARY VASCULITIS • Lymphopenia with normal helper T-cells to suppressor T-cells ratio • Increased conc. Of immune complexes • Anticardiolipin antibodies • Reduced antibody affinity to retinal-S antigen • Increased expression of IL-2 surface markers But their significance still remains to be seen
- INFECTIOUS VASCULITIS • Vascular endothelium invaded by microorganisms result in cell injury & death • Immune complexes form with antigenic components of microorganisms, activates complement system, attract leukocytes & induce inflammation
- IMMUNE VASCULITIS • May be T cell mediated as in graft rejection, giant cell arteritis & takayasu disease • Ag-Ab & immune complex deposition is main mechanism including eye • Anti-endothelial cell antibody and anticardiolipin antibodies are also associated with retinal vasculitis
Retinal vasculitis