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Chorioretinitis: Causes, Symptoms and Treatment

Chorioretinitis is an inflammation of the choroid and retina of the eye. It can threaten vision and requires prompt medical evaluation and treatment.

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Things worth knowing about "Chorioretinitis"

Chorioretinitis is an inflammation of the choroid and retina of the eye. It can threaten vision and requires prompt medical evaluation and treatment.

What Is Chorioretinitis?

Chorioretinitis is an inflammatory condition affecting both the choroid (a layer of blood vessels behind the retina) and the retina (the light-sensitive tissue lining the back of the eye) simultaneously. Because these two structures are anatomically adjacent in the posterior segment of the eye, inflammation frequently involves both at once. Chorioretinitis falls under the category of posterior uveitis and can lead to permanent vision impairment if not diagnosed and treated promptly.

Causes

Chorioretinitis can be caused by a wide range of infectious agents or systemic conditions. The most common causes include:

Toxoplasmosis: The most frequent cause worldwide, caused by the parasite Toxoplasma gondii. Congenital infection acquired before birth may reactivate later in life, causing inflammation.
Cytomegalovirus (CMV): Particularly relevant in immunocompromised individuals, such as those living with HIV/AIDS or organ transplant recipients.
Herpes viruses: Both herpes simplex virus (HSV) and varicella-zoster virus (VZV) can trigger chorioretinitis.
Tuberculosis: Systemic infection with Mycobacterium tuberculosis may manifest in the eye.
Syphilis: Infection with Treponema pallidum is a well-recognized ocular cause.
Autoimmune diseases: Conditions such as systemic lupus erythematosus may be associated with chorioretinitis.
Fungal infections: Rare, but Candida species can cause chorioretinitis, especially in immunosuppressed patients.

Symptoms

Symptoms can vary depending on the location and extent of the inflammation. Common signs and symptoms include:

Blurred or reduced vision
Floaters (moving spots or threads in the visual field caused by vitreous opacities)
Photophobia (increased sensitivity to light)
Scotomas (blind spots in the visual field)
Distorted vision (metamorphopsia), especially when the macula is involved
Eye pain or redness in some cases

Important: Even small inflammatory lesions involving the central retina (macula) can cause significant visual loss.

Diagnosis

Diagnosis of chorioretinitis is primarily based on an ophthalmological examination:

Fundoscopy (ophthalmoscopy): Visualization of typical whitish-yellow inflammatory lesions on the retina and choroid.
Slit-lamp examination: Assessment of inflammatory cells in the vitreous humor.
Fluorescein angiography: Imaging of vascular changes using a contrast dye injected into the bloodstream.
Optical coherence tomography (OCT): High-resolution cross-sectional imaging of the retinal layers.
Laboratory tests: Blood tests for infectious agents (e.g., Toxoplasma antibodies, CMV PCR, syphilis serology, HIV testing, tuberculin skin test).
Vitreous biopsy: In unclear cases, a sample of vitreous fluid may be taken for microbiological analysis.

Treatment

Treatment depends on the underlying cause of the inflammation:

Infectious Causes

Toxoplasmosis: Combination therapy with pyrimethamine, sulfadiazine, and folinic acid; alternatives include clindamycin or trimethoprim/sulfamethoxazole.
CMV retinitis: Antiviral therapy with ganciclovir, valganciclovir, or foscarnet.
Herpetic infections: Acyclovir or valacyclovir administered intravenously or orally.
Tuberculosis and syphilis: Specific antibiotic regimens according to current treatment guidelines.

Anti-inflammatory Therapy

Corticosteroids (e.g., prednisolone) are often used as adjunct therapy to reduce the inflammatory response -- but only after initiation of pathogen-specific treatment, as steroids alone can worsen infectious chorioretinitis.
For autoimmune causes, immunosuppressants such as methotrexate or mycophenolate mofetil may be prescribed.

Prognosis and Follow-Up

When diagnosed early and treated appropriately, the inflammation can usually be controlled. However, retinal scarring is common and may result in lasting visual deficits, particularly if the macula is involved. Regular ophthalmological follow-up is therefore essential for all affected patients.

References

Kasper DL et al. (Eds.): Harrison's Principles of Internal Medicine, 21st Edition. McGraw-Hill, 2022.
Kanski JJ, Bowling B: Clinical Ophthalmology: A Systematic Approach, 8th Edition. Elsevier, 2020.
Bodaghi B, Cassoux N, Wechsler B, et al.: Chronic severe uveitis: etiology and visual outcome in 927 patients from a single center. Medicine 2001; 80(4): 263–270. PubMed PMID: 11470986.

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