What is Choroiditis?
Choroiditis is inflammation of the choroid, which is located in the back of the eye behind the retina. Choroiditis affects the choroid either entirely, known as multifocal choroiditis or in patches, called focal choroiditis, and can cause blurred vision, eye pain and redness
- Choroiditis can present with a variety of symptoms, including vision loss, eye pain and redness.
- Women are four times more likely affected by choroiditis than men, and the average age range of affected patients at the time of diagnosis is 35 years.
- Treatment of choroiditis includes Inflammation control with steroid eye drops or injections, and antibiotics when needed.
The choroid is a highly pigmented and vascular layer of the eye, located between the retina and the sclera. Since the choroid is responsible for the blood circulation to the outer parts of the retina, choroiditis can result in vision-threatening problems.
Choroiditis is a type of posterior uveitis (inflammation of the uvea – iris, choroid and ciliary body) with a geographic pattern of extending from the juxtapapillary choroidal and spreading centrifugally at times. The outer retina and the overlying retinal pigment epithelium are both affected by choroiditis.
Presentation of Choroiditis
Choroiditis is usually bilateral, affecting both eyes. However, it can occur unilaterally as well. The symptoms can be limited to one eye at the time of presentation, but the other second eye may have previously undiagnosed healed lesions from past episodes of choroiditis. Choroiditis typically afflicts women more than men, and middle-aged people with no familial or ethnic predisposition. The typical duration between one eye’s presentation and the second eye’s onset is roughly five years. Unilateral instances are more common in tuberculosis-endemic areas.
Causes of Choroiditis
Choroiditis has many causes, including infectious and non-infectious. Toxoplasma gondii is the most common, and is usually spread by eating tissue cysts found in raw or undercooked meat or by ingesting oocysts found in cat feces. Other infectious causes include: viruses (cytomegalovirus, herpes simplex, and others), HIV, tuberculosis, toxocara, syphilis, bartonella and candida. Non-infectious causes include sarcoidosis and Behcets disease. In some instances, the cause remains unclear, which can make treatment difficult.
Complications of Choroiditis
The most common complication of choroiditis is cystoid macular edema, optic atrophy, cataract, glaucoma, other macular edema, posterior synechiae and pigmentary retinopathy. Birdshot retinochoroiditis, sarcoidosis, and other uveitis that produce significant vitreous inflammation are all known to cause macular edema.
Choroidal neovascularization is more common when choroidal involvement occurs and the Bruch’s membrane is disrupted. Presumed ocular histoplasmosis syndrome, multifocal choroiditis and panuveitis, serpiginous choroiditis, and punctate inner choroidopathy are some of the causes of choroidal neovascularization.
Congenital toxoplasmosis is a feared complication when a typically asymptomatic mother can pass the disease to the fetus. The typical trio of congenital toxoplasmosis includes choroiditis, cerebral calcifications, and hydrocephalus. Congenital cytomegalovirus is one of the most common viral infections passed from mother to fetus, and can cause chorioretinitis, cataract, and optic atrophy. Other systemic complications include jaundice, cirrhosis, loss of heating and calcifications in the brain.
Treatment of Choroiditis
The following medications can be used to treat choroiditis:
- Inflammation can be controlled with topical, oral or injectable steroids
- Topical, injections or oral antibiotics when infection is suspected
- Dilating drops to prevent the iris from scarring onto the lens