Ophthalmology

Choroidal inflammation

What is choroidal inflammation?

An inflammation of the choroid is also known as choroiditis and describes an inflammation of the choroid, which lies between the retina and the dermis.

The choroid is responsible for supplying nutrients and regulating the temperature of the retina. Often the inflammation affects the retina at the same time, so that in most cases one Chorioretinitis speaks.

It often occurs in the context of other diseases or in infections with pathogens such as toxoplasmosis, tuberculosis or candida fungi. In the ophthalmological examination, the fundus of the eye often shows white spots. Due to the lack of nerves in the choroid, the choroidal inflammation does not cause pain and is particularly noticeable in the form of impaired vision.

Also read: Choroid

causes

The causes of a choroidal inflammation are varied and can have very different origins. The exact cause is often not fully understood.

Choroiditis often occurs in the context of other diseases, such as inflammatory bowel diseases (Crohn's disease, ulcerative colitis).
They are also common in rheumatic diseases such as Behcet's disease or scleroderma.
In most cases, however, an infection by bacteria, viruses, parasites or fungi is the cause.
If the teeth or tonsils are infected, pathogens can spread to the eye via the bloodstream. Important pathogens of choroidal inflammation are toxoplasmosis pathogens, cytomegalovirus, tuberculosis bacteria or candida fungi.

Other diseases in which there is an increased incidence of choroidal inflammation are: herpes simplex, chickenpox, rubella, syphilis, borreliosis, AIDS and histoplasmosis. The choroid inflammation often occurs in immunosuppressed patients. In most cases there is no isolated choroiditis, but inflammation of the entire posterior vascular layer (posterior uveitis).

Concomitant symptoms

A choroidal inflammation is primarily noticeable in the form of a deterioration in vision. Patients often complain of distorted vision and black spots in front of the eyes. In the course of the disease, visual field deficits can occur in the area of the foci of inflammation. Symptoms can also be increased sensitivity to glare or reddening of the eye. The choroidal inflammation often leads to increased internal pressure.

In contrast to the other layers of the retina, the choroid does not contain any sensitive nerve fibers. This means that no pain can be perceived in the retina. Correspondingly, affected patients feel no pain with an isolated choroidal inflammation. As a rule, however, it is not the choroid alone that is affected, but several layers at the same time. For example, chorioretinitis, which also affects the retina, can also cause pain.

You may also be interested in the following article: Inflammation of the eye

diagnosis

The diagnosis of choroidal inflammation is made by the ophthalmologist with the help of an ophthalmoscopy or fundoscopy. The posterior segment of the eye can be assessed with this examination. With this ophthalmoscope the doctor can in most cases see white or yellow, blurred, round spots that represent foci of inflammation on the choroid. Depending on the level of activity of the inflammation, they can be different.

For further diagnosis and to rule out other diseases, a slit lamp examination and measurement of the intraocular pressure (tonometry) can also be carried out. In some cases, optical coherence tomography (OCT) can also be helpful, in which the layers of the retina can be shown in detail.

Also read: Opthalmoscopy - the ophthalmoscope, measurement of intraocular pressure

Treatment / therapy

Treatment of choroidal inflammation depends on the cause. Therefore, the quick and comprehensive diagnosis is very important for the correct therapy decision.

If a bacterial infection is the cause of the choroiditis, treatment is primarily carried out with antibiotics. The choice of antibiotic depends on the causative agent.
The same applies to a viral infection, in which appropriate antivirals must be given.
If there is no infection and the inflammation occurs as part of rheumatic or other diseases, the administration of cortisone is usually indicated. Depending on the severity of the disease, the cortisone can be given locally in the form of drops or directly into the bloodstream. The cortisone has an anti-inflammatory effect.
If the intraocular pressure is increased, additional pressure-lowering agents must be given.

In very severe cases that do not heal, surgical therapy can prevent complications from occurring.

Also read the following articles: Antibiotics, anti-virus drugs, cortisone

Duration

The duration of a choroidal inflammation depends on the cause.

With quick diagnosis and well-responding therapy, it usually heals completely within a week.
However, in chronic rheumatic inflammation or immunocompromised patients, healing can take longer and lead to further complications. In addition, there may be repeated recurrences or the inflammation becoming chronic.