Posterior Uveitis / Chorioretinitis
- Definition:
- Inflammation of the choroid and retina.
- Clinical Features:
- Floaters
- Painless loss of vision
- Scotoma (blind spot)
- Metamorphopsia (distortion of image)
- Photopsia (flashing lights)
Causes:
ㅤ | Infectious chorioretinitis | ㅤ |
1 | Toxoplasmosis | • Active: "Headlight in a fog" appearance • Chronic: "Punched out" scar. • Eccentric target sign (basal ganglia m/c) Toxic guy () saw a headlight in a fog () and got a punch () |
2 | Toxocariasis | • Unilateral vision loss • Leukocoria (white pupillary reflex). • Causes focal chorioretinitis. |
3 | CMV Retinitis | • Causes focal chorioretinitis. • Pizza pie appearance • Scrambled egg & Ketchup appearance • Brushfield extension CMV → Come we have Pizza, scrambled egg and ketch up, So brush and come |
ㅤ | Multifocal chorioretinitis | ㅤ |
1 | Tuberculosis (TB) | • Conglomerate lesion • MRS → Lipid peak |
2 | Herpes Simplex Virus (HSV) | ㅤ |
3 | Syphilis | ㅤ |
ㅤ | Non-Infectious Posterior Uveitis | Features |
1 | Sarcoidosis | • M/c ocular manifestation: Granulomatous AU • Candle wax dripping ↳ d/t perivascular inflammation and sheathing • Lander's sign: ↳ Pre-retinal nodules |
2 | Birdshot Chorioretinopathy | • HLA-A29 |
3 | Serpiginous Choroiditis | • HLA-B7 |
4 | Behcet's Disease | ㅤ |
- Non-Infectious Posterior Uveitis causes
- Saratha (Sarcoidosis) with a bird (Birdshot), snake (Serpiginous) in a bus (Behcets)
Sarcoidosis Ophthal Findings:
- M/c ocular manifestation: Granulomatous AU
- Candle wax dripping appearance
- (due to perivascular inflammation and sheathing).
- Lander's sign:
- Pre-retinal nodules.
- Saratha from candle wax (candle wax sign) land (Landers sign)
Toxoplasmosis
CD4 Count vs Opportunistic Infections
CD4 Count | Infections/Findings | ㅤ |
~600 | • Lymph node enlargement | 6 swellings → LNs |
~500 | • Herpes Zoster Virus • Pneumococcus (lobar consolidation) | ㅤ |
~400 | • Kaposi Sarcoma (any CD4) • Tuberculosis (snowstorm/hazy) | 4K TB |
~300 | • Oral Hairy Leukaemia | 300 Hairs |
<200 | • PCP (perihilar opacities), • Miliary TB, Candida, Cryptosporidium • Mucocutaneous Herpes | ㅤ |
<100 | • Cerebral Toxoplasmosis, • Cryptococcal Meningitis, • CNS Lymphoma, HIV Dementia, PMLE | 100 = Brain |
< 50 | • CMV Retinitis • MAC | ㅤ |
Congenital toxoplasmosis CT
- Eccentric target sign.
- M/c site: basal ganglia
- Most common infectious cause
- Mnemonic: Toxic guy () saw a headlight in a fog () and got a punch ()
- Active: "Headlight in a fog" appearance
- (due to associated vitritis).
- Chronic: "Punched out" scar.
Cryptococcosis:
- Soap bubble appearance.
- Cry when bathing with soap
CNS lymphoma:
- Solitary enhancing peripheral lesion.
Cytomegalovirus (CMV) Retinitis
- Most common cause of vision loss in ocular HIV.
- Mnemonic:
- CMV → Come we have Pizza, scrambled egg and ketch up,
- So brush and come
Features:
- "Pizza pie" appearance.
- "Scrambled egg and ketchup" appearance.
- "Brushfire extension" pattern.
- Causes focal chorioretinitis.
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