Chorioretinitis

Chorioretinitis – General Information

Chorioretinitis is an inflammation which affects the retinal vessels and which is usually caused by other bacterial, viral or propozoan infections located in different parts of the body. In what concerns the younger patients, they usually develop this disorder because of the congenital toxoplasmosis or congenital cytomegalovirus. On the other hand, in what concerns the older patients, the disease can appear because of some acquired or reactivated problems. Chorioretinitis is characterized by an inflammation which is located in the eyeball, more specifically in the retina. It usually tends to be stable and to improve during the first years of life, but in some cases, it continues to develop and it becomes clinically significant when the patient is older. The number of appearances is influenced be the area the sufferer lives in; the frequency rate is higher in Europe than it is in SUA. It is more likely to affect older people and not young children, due to the immunologic status. If Chorioretinitis is not treated carefully or if the patient receives no treatment at all, the disease can evolve fast and it can cause a total loss of vision. In the most severe cases, the disorder can lead to damage of other organs; if the brain is affected, the patient could die.  The congenital form of this disease is noticed at birth; in these cases, it progresses and it manifests when the sufferer is about 5 years old. In what concerns the acquired form of this disease, it can appear at any age.

Chorioretinitis – Symptoms

The most common signs and symptoms which a patient can develop in the case of Chorioretinitis are: Intrauterine retardation, microphtalmia, microcephaly, cataract, hearing problems, enlarged spleen and liver, uveitis, osteomyelitis, dermal erythropoiesis, heart disease, lymohadenopathy, carditis, vessel trauma, and so on.

In most of the cases, the patient medical history is not important in establishing the causes which lead to the appearance of Chorioretinitis. In what concerns the maternal acquired form of the disease, the herpes, syphilis and rubella appear insidiously and are not relevant. In the case of the acquired type, the only problems which could be related to the disease are: toxoplasmosis (eating undercooked meat, handling kitten wastes) 

If the inflammation affects only one eye, the sufferer could notice the impossibility to see objects; in some cases, patients can report photophobia, poor walking balance or clumsiness.
The most common causes which lead to the appearance of this disease are: Congenital infections: viral etiologies (rubella, perinatal or vertical infections, flavi-virus, varicella) , toxoplasma gondii; noninfectious diseases: collagen vascular, sarcoid, sarcoidosis, chronic granulomatous disease, chronic granulomatous; acquired form of the disease in the case of immunocompetent children: they can develop ocular larva migrans or visceral larva migrans; immunocompromised children: in this case, the disease is associated with general infections, invasive fungal infections and systemic infections.  
If you present one of the symptoms described above or if you suffer from one of the disease presented, you should visit a doctor immediately.

Chorioretinitis – Treatment

• A neurologist: in order to establish the follow-up care and to determine the neurological problems this may appear.
• An ophthalmologist: in order to determine the exact levels of eye damage and to choose the best treatment.
• An audiologist: in order to measure correctly the level of deafness and to treat this problem if possible
• An immunologist: in order to establish the length of the treatment, the treatment options and possible toxicity of the drugs which are administrated.
• A physical therapist: in order to create a follow-up schedule for improving the patient’s condition.  
• A gynecologist: if some genetic tests are needed 

The treatment which the doctor will administrate you in the case you suffer from Chorioretinitis focuses on the stabilization of the patient, the elimination of the symptoms and further complications and complete healing. However, the treatment is complex and it should be organized in short-term care and long-tem care of the sufferer; it should also establish further goals to assure a quality life of the patient. An effective treatment for Chorioretinitis has not yet been found. The combination and the quantity of the drugs which are administrated should carefully be established by your doctor.
In what concerns the eye symptoms, they can be treated as following:

• Administration of steroids which play an important role in improving collagen vascular diseases, sarcoids, vasculitides.
• laser treatment; in some conditions, these way of treatment can prove quite useful
• intraocular implants: this method is performed using ganciclovir
• intravenous amphotericin administration
• infusions with supplemental immunoglobulin

In some severe cases, the doctor could choose to perform a vitrectomy; in this case, he should measure carefully the levels of antibodies, eosinophils and immunoglobulin. In this way, he will separate the malignant retinoblastoma from the ocular larva migrans and he will not cause any unnecessary enucleations.
In the case of young children who suffer from Chorioretinitis some severe problems can appear and they could suffer from some handicaps: total vision loss, mental retardation, deafness. In extreme cases, some of the children who are born with this disorder also suffer from HIV infections.
Another important thing which the patients should know is the fact that the long-term care is extremely important after the treatment is administrated. They should consult one or more of the doctors who were presented above; in addition, a special relation should be developed with the specialists, as well with the social workers and the public system.  In order to reduce the number of children who are born with Chorioretinitis, the medical centres should provide more information and the doctors should advise the pregnant women to take all the necessary tests.