The Retina and Choroid (Part 8) Both traumatism and myopia can cause changes that produce similar pictures. We occasionally encounter disseminated choroiditis in pregnant women associated with albuminuria, which may extend to the choroid from albuminuric retinitis of pregnancy. This condition has been attributed to malaria, kidney disease, diabetes, rheumatism, gout, acute infectious diseases, nasal and pharyngeal affections, malnutrition, anemia, and chlorosis. Ball attributes it in young, healthy subjects to excessive near work of the eyes, whether refractive errors have been corrected or not. We are fairly certain that intestinal disorders can cause this condition, though evidence is often lacking. Treatment directed at the intestines sometimes leads to moderate improvement. We can always determine if a patient suffers from syphilis, tuberculosis, or other demonstrable organic diseases, but in some cases, no such disease is found. Tuberculous Choroiditis Some writers differentiate between diffuse inflammation of the choroid (tuberculous choroiditis) and circumscribed metastatic lesions caused by colonies of bacilli (tuberculosis of the choroid). This distinction may become valuable in the future but has little bearing on prognosis or treatment now. When examining a very sick patient, usually a child with symptoms indicative of acute miliary tuberculosis or meningitis, we find round or oval yellowish-white elevated spots about half as large as the papilla, which have ill-defined margins. Occasionally, we see a brilliant white elevation of part of the papilla with grayish edema of adjacent retina, indicating tubercles or conglomerates of tubercles in the optic nerve. In chronic forms of tuberculosis, these lesions may disappear under treatment or change to present the picture of disseminated choroiditis. In another child, we find a yellow, gray, green, or blue tumor as large or larger than the papilla projecting into the vitreous. If such a tumor is without vessels and reacts distinctly to the tuberculin test, glioma of the retina and sarcoma of the choroid are excluded, and we know that we have to deal with a solitary or conglomerate tubercle of the choroid. <Callout type="important" title="Critical Diagnosis">Early differentiation between tuberculous lesions and other conditions is crucial for proper treatment.</Callout> PURULENT CHOROIDITIS When a patient suffering from septicemia derived from puerperal fever, ulcerative endocarditis, caries of the bones, or acute infectious diseases like measles, scarlet fever, mumps, tonsillitis, cerebrospinal meningitis, influenza, diphtheria, pneumonia, or typhoid fever experiences rapid and total loss of vision with or without severe iridocyclitis, we fear septic emboli have lodged in the choroid. If seen quickly, we may find fundus appearance resembling that observed in septic retinitis or some yellowish spots visible but within hours everything becomes hidden by opacities in the vitreous. GLIOMA OF THE RETINA A mother brings a child because she noticed something yellow in one of his pupils. The child is usually healthy, has no pain or redness of the eye, clear anterior media, and normal tension. With an ophthalmoscope, we find a yellowish or reddish-yellow elevated lobulated mass in the vitreous, perhaps spotted with lustrous white spots, covered with ramifying blood vessels, some embedded in tissue, sometimes surrounded by bluish or greenish detachment of retina. <Callout type="risk" title="Severe Condition">Glioma is very malignant and early diagnosis is crucial for survival.</Callout> The tumor may appear first in one eye then the other or be confined to one alone. The average length of life after discovery is about a year and a half, with only recoveries following early enucleation. <Callout type="beginner" title="Understanding Glioma">Gliomas are rare but serious tumors that require immediate medical attention.</Callout> The tumor may be small enough to see considerable fundus, surrounded by grayish ring looking like edema, little hemorrhages in retina or about papilla, black and white spots indicative of choroiditis. We seldom see this picture as most cases are advanced when noticed.
Key Takeaways
- Disseminated choroiditis can be caused by various conditions including pregnancy, kidney disease, and intestinal disorders.
- Tuberculous lesions in the retina or choroid require careful differentiation from other conditions for proper treatment.
- Gliomas are serious tumors that often affect children and demand early diagnosis and intervention.
Practical Tips
- Maintain a high index of suspicion for disseminated choroiditis when dealing with pregnant women, especially those showing signs of kidney disease or albuminuria.
- Use the tuberculin test to differentiate between solitary or conglomerate tubercles and other conditions in suspected cases of tuberculous lesions.
Warnings & Risks
- Failure to diagnose and treat gliomas early can lead to severe complications, including death within a year and a half.
- Symptoms such as yellow reflex from the pupil and blindness should prompt immediate medical attention for potential glioma diagnosis.
Modern Application
While this chapter focuses on historical diagnostic methods for retinal and choroidal disorders, many of its principles remain relevant today. The importance of early detection and differentiation between various conditions is still crucial in modern ophthalmology. However, advancements in imaging technology have greatly improved the accuracy and speed of diagnosis.
Frequently Asked Questions
Q: What are some common causes of disseminated choroiditis?
Disseminated choroiditis can be caused by various conditions including pregnancy (especially with albuminuria), kidney disease, diabetes, rheumatism, gout, acute infectious diseases, nasal and pharyngeal affections, malnutrition, anemia, and chlorosis.
Q: How is tuberculous choroiditis differentiated from other conditions?
Tuberculous lesions in the retina or choroid require careful differentiation through clinical examination and tests such as the tuberculin test. A response to this test can help confirm the presence of a solitary or conglomerate tubercle.
Q: What is the prognosis for glioma?
The average length of life after discovery of a glioma is about one and a half years, with only recoveries following early enucleation. Early diagnosis and intervention are crucial for survival.