RETINITIS (retinitis; late lat. retina a mesh cover + - itis) — an inflammatory disease of a retina. Many forms of inflammatory diseases of a retina are not strictly localized since in process it is involved and actually choroid of an eye (see) — horioideya therefore for them more exact term is the chorioretinitis, or retinokhorioidit (see. Choroiditis ). The term «retinitis» it is not necessary to designate diseases of circulator and exchange genesis (retinopathy) or a dystrophic origin.
R.'s Emergence is often connected with a hematogenous drift in a retina from the centers of an infection in an organism of streptococci, stafilokokk, pneumococci, etc., and also their toxins. In some cases R. can have a virus etiology (e.g., at flu, herpes, shingles, etc.). Quite often R. arises at tuberculosis, toxoplasmosis and syphilis. R. at a leprosy, typhus, an actinomycosis, a sarcoidosis meet. Sometimes R.'s development is caused by impact of light, ionizing radiation, and also damages retinas (see).
Depending on an etiology of a disease distinguish tubercular, syphilitic, toksoplazmozny, metastatic, solar, leprose R., etc. (see below).
In an active stage of R. there is a disorganization and destruction of a retina with formation of inflammatory focus, at the edges to-rogo accumulation of lymphocytes, plasmocytes, eosinophils and phagocytes is noted. Migration of cells of a pigmental epithelium to inner layers of a retina is observed. At the same time in inner layers of an idiovascular cover lymphocytic infiltration appears. As a result of the organization of inflammatory focus retinokhorioidalny cicatricial fabric is formed. Nervous elements of a retina at R. break up and replaced with connecting fabric; nerve fibrils are varicose thickened; ganglionic cells (ganglionic neurocytes) and basic fibers of Müller are exposed to fatty dystrophy (beam gliotsi-you). Are involved in process of a stick and a flask, to-rye at late stages of a disease destructions are exposed.
The main subjective symptom of R. — decrease visual acuities (see). Its degree depends on localization of process. The greatest disturbance of the central sight happens at R.'s localization in a macular zone (in a zone of a macula lutea — maculae), at the same time suffers also color perception. Quite often patients complain of the distorted vision of objects (see. Metamorphopsia ), and also abnormal subjective light feelings in eyes in the form of gloss, lightnings, sparks, etc. (see. Photopsia ). At a research fields of vision (see) define central, paracentral or peripheral scotomas (see), to-rye can be absolute or relative, positive or negative.
Peripheral localization of R. is followed by changes of borders of a field of vision, disturbances of dark adaptation, various on a configuration, to-rye later favorable permission of process can disappear. By means of an oftalmoskopiya at R. find white and yellowish color focuses, to-rye in an active phase of a disease are represented friable with the indistinct borders surrounded with a zone of hypostasis of a retina.
Vessels of a retina usually change at defeat of their walls (vasculites). Changes can be various: narrowing or vasodilatation, irregularity of their caliber, partial obliteration, formation of couplings, etc. Quite often there are extensive hemorrhages in the retina and under it.
Active inflammatory process on an eyeground causes reaction of a vitreous, in Krom exudate appears. Detection it in a vitreous helps to differentiate inflammatory process on an eyeground from dystrophic.
Decrease of the activity of process is followed by consolidation of the center, borders to-rogo become more accurate. Old chorioretinal focuses have a clear boundary, white and gray color with adjournment glybok a pigment. After permission of active inflammatory process on a retina there can be extensive chorioretinal hems relating to secondary dystrophies of a retina.
In diagnosis and differential diagnosis of R. data of an oftalmoskopichesky research are important (see. Oftalmoskopiya ) and a fluorescent angiography of an eyeground (see. Fluorescent angiography ). By means of these methods fresh inflammatory focus (it is contrasted in late terms) or old focus with destruction of a pigmental epithelium can be revealed (it is contrasted in early terms). R.'s etiology is established on the basis of assessment of a condition of the patient, data of his general inspection, statement of special diagnostic tests.
Separate forms of a retinitis
the Tubercular retinitis
the Tubercular retinitis most often develops at inactive forms of tuberculosis. In spite of the fact that in clinic tubercles of a retina and exudative tubercular R.'s picture are observed, tuberculosis of a retina should be considered secondary in relation to tubercular defeat of a choroid of an eyeglobe. Therefore it is more correct to speak about a tubercular chorioretinitis, and also about a tubercular vasculitis, following an inflammation ciliary body (see) or idiovascular cover.
Tubercular R. is shown in the form of a konglobirovanny tubercle. In an initial phase of development is the center of grayish-white color with indistinct borders (tsvetn. fig. 1). Then the tubercle gradually grows and takes a form of the tumor of white or yellowish color pro-mining in a vitreous. At the edges of a tubercle small exudative ochazhka are located. On a surface of a tubercle there are small hemorrhages, the retina stretches, forms folds that can lead to its amotio (see. Amotio of a retina ).
A common form of tubercular defeat of an eyeground are the miliary chorioretinitis and the disseminated tubercular chorioretinitis (see tsvetn. the tab. to St. Eyeground , fig. 50 — 54).
The tubercular defeats causing changes of venous and arterial vessels of a retina give a picture of a periphlebitis and a periarteritis. On vessels «couplings» or exudative deposits in the form of separate small spots are defined by Oftalmoskopicheski. About the struck vessels small hemorrhages are visible. Periphlebites often are complicated by the recurrent vitreous hemorrhages leading to sharp decrease in sight.
At localization of tubercular focus about an optic disk there is a neuroretinitis (a synonym: the circinate retinitis, a peripapillary chorioretinitis of Janszen, an okolososochkovy neuroretinitis of Janszen, yukstapapillyarny retinokhorioidit Janszen). At the same time the corresponding part of an optic disk is involved in inflammatory process. A neuroretinitis not patogno-monichen for tuberculosis. It meets also at a toxoplasmosis, virus defeats and syphilis.
Tubercular process in the field of an optic disk, taking an idiovascular cover, can give a picture of a so-called «geographical» horioretinpt, being followed by a focal atrophy of a choroid of an eye, development of subretinal neovascularization.
Tubercular R.'s treatment shall be complex and is coordinated with phthisiatricians. Local and general specific therapy is shown (see. Tuberculosis ); in the outcome of a disease use the means increasing metabolism of a retina, and vasodilating drugs.
The forecast is serious, depends on timely diagnosis at sick tuberculosis and efficiency of the carried-out treatment.
Prevention consists in timely treatment of tuberculosis.
The syphilitic retinitis
the Syphilitic retinitis (chorioretinitis) can develop at the inborn and acquired syphilis.
At inborn syphilis four types of a horioretinpt are described (see tsvetn. the tab. to St. Eyeground , fig. 56 and 57): the first look — on the extreme periphery of an eyeground is available a large number of light yellow and black ochazhok (the picture by outward reminds mix of salt with pepper); the second look — on peripheries of an eyeground the large pigmental centers decide on certain sites of an atrophy of a choroid of an eyeglobe; the third look — the same picture, as at the second look, but with dominance of the atrophic centers in an idiovascular cover; the fourth look — change of an eyeground reminds pigmental dystrophy of a retina.
At the first three types of an inborn syphilitic horioretinpt sight is usually not broken, the fourth look is always followed by visual disturbances.
At the acquired syphilis the diffusion chorioretinitis is most typical Ferstera who is usually arising at secondary and tertiary syphilis (retinokhorioidit). The disease proceeds with diffusion hypostasis of a retina, an optic disk and existence of a thin diffusion suspension and more rough floating flakes in a vitreous. Retinal hemorrhages can be noted. At permission of an acute phase of process on an eyeground the multiple sites of an atrophy of an idiovascular cover which are partially pigmented form (see tsvetn. the tab. to St. Eyeground , fig. 58). Quite often syphilitic changes of a retina are accompanied by a vasculitis.
Treatment is complex, it has to be coordinated with dermatovenerologists. Specific therapy is shown (see. Syphilis ); topical and general administration of corticosteroids; the spasmolysants and pharmaceuticals increasing metabolism of a retina.
Prevention consists in early identification and adequate treatment of a basic disease.
The Toksoplazmozny retinitis
the Toksoplazmozny retinitis (chorioretinitis) takes an important place among inflammatory defeats of an eyeground. Toksoplazmozny R. divide on inborn and acquired.
Inborn toksoplazmozny R. proceeds as a bilateral chorioretinitis and comes to light against the background of hydrocephaly (see) or nanocephalias (see). Radiological intracranial calcificats are found. Usually this disease is diagnosed already in the absence of the inflammatory phenomena when on an eyeground find the cicatricial changes which developed after the postponed pre-natal chorioretinitis (see tsvetn. the tab. to St. Eyeground , fig. 55). Cicatricial changes in a form can remind a coloboma of a macula lutea (pseudocoloboma).
The classical picture of toksoplazmozny R. consists in education central fresh, rounded shape, the friable center of the gray-yellow and chartreuse color surrounded with perifocal hypostasis and is frequent hemorrhages (tsvetn. fig. 2). The old toksoplazmozny centers represent cicatricial or atrophic focuses, sometimes with formation of a subretinal neovascular membrane (tsvetn. fig. 3). The opacity of the vitreous body with existence of inflammatory cells is often observed.
At localization of the center about an optic disk (in a peripapillary zone) there is a picture of a neuroretinitis. Sometimes process has a picture of the disseminated chorioretinitis. At considerable exudation exudative amotio of a retina can develop.
Treatment is complex, it has to be coordinated with therapists and doctors of other specialties; includes specific therapy (see. Toxoplasmosis ), the streptocides, vasodilators and means increasing metabolism of a retina.
Prevention consists in active identification of patients with a toxoplasmosis and their timely treatment.
The leprose retinitis
the Leprose retinitis meets seldom, generally at lepromatous type leprosies (see) it is also connected with infiltration of fabrics of an eyeglobe mycobacteria of a leprosy. During the involvement in process of an idiovascular cover of an eye in the field of an eyeground, is closer to the periphery there are round, yellow color small knots reminding a pearl. These changes are not always available to observation since in most cases they are combined with besides (see. Iridocyclitis ) and back synechias (unions between an iris of the eye and a crystalline lens) owing to what it is difficult to expand a pupil.
Treatment surely includes specific therapy.
In leprose R.'s prevention identification and treatment of patients in the earliest terms is of great importance.
The metastatic (septic) retinitis
the Metastatic (septic) retinitis is characterized by symptoms of the intraocular infection connected with hron. recurrent diseases of various bodies (heart, kidneys, liver, brain, etc.). Damage of eyes at these diseases is noted approximately in 50% of cases. A contagium most often is the streptococcus (Streptococcus viridans). Changes in a retina happen in the form of the flame hemorrhages reminding Roth's spots (see. Retinopathies ), the white centers located under vessels of a retina, hypostasis of a retina and an optic disk.
Treatment is carried out together with therapists and doctors of other specialties. Antiinflammatory therapy, including topical and general administration of antibiotics, corticosteroids is shown. Also use the spasmolysants and pharmaceuticals increasing metabolism of a retina.
Prevention consists in perhaps early identification and timely treatment of a basic disease.
The solar (foveomakulyarny) retinitis
the Solar (foveomakulyarny) retinitis results from long radiation of eyes a direct sunlight, napr, at observation of a solar eclipse without protective glasses. It is considered that foveomakulyarny R. arises hl. obr. as a result of photochemical impact on a retina and a pigmental epithelium. Soon after radiation positive central appears scotoma (see), a chromatopsia (the distorted perception of color), a metamorphopsia and a headache. On an eyeground — the yellow-white spots surrounded with a grayish rim. Color of spots gradually changes and approximately in 10 — 14 days they turn into the small, red, accurately outlined zones of defeat.
Treatment complex. Antibiotic treatment, topical and general administration of corticosteroids, in the outcome of a disease — the vasodilators and means stimulating metabolism of a retina is shown.
Prevention consists in protection of eyes against light radiation.
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L. A. Katsnelson.