Infectious and Inflammatory Retinal Diseases

Infectious and Inflammatory Retinal Diseases

Brittany E. Powell

Victoria M. Hammond


Infectious and inflammatory retinal diseases are typically progressive and have significant ocular morbidity. Early and accurate diagnosis is critical to initiating immediate therapy and hinges on a high index of suspicion. The clinical challenge for the retinal pathology described in what follows is that the described disease entities are rare and might be encountered only occasionally during the career of any physician. However, a high index of suspicion with initiation of treatment and engagement with an ophthalmologist will result in dramatically improved outcomes.


The most important part of the exam is the medical history and timeline of symptoms in order to develop an adequate differential diagnosis. Endophthalmitis is rare but must be suspected in patients experiencing vision loss, pain, and photophobia following intraocular surgery or trauma. Endogenous endophthalmitis must be considered in those who are systemically ill or immunocompromised with gradual deterioration of vision or worsening of visual symptoms. Inflammatory retinal diseases typically present with gradually worsening photophobia, photopsias, floaters, and decreased vision. In contrast to iritis, vision loss is usually severe. Consideration for an undiagnosed systemic inflammatory condition in these patients is critical.

The history should include recent trauma, recent intraocular surgery, current medications, and the potential for immune suppression caused by underlying diseases or medication use. Is the patient experiencing vision loss, pain, eye discharge, redness, flashes, or floaters? When did the symptoms start? Have the symptoms progressed over hours, days, or weeks? Patients who have had glaucoma surgery are at risk for endophthalmitis even months or years after surgery, owing to the presence of a drainage bleb or implant. After cataract surgery or intraocular injection, the risk of endophthalmitis is significant only in the acute postoperative period.

The examination should consist of vital signs, visual acuity, intraocular pressure, and an external exam of the eyelids to assess for swelling, redness, and discharge. A slit lamp exam can assess for a red reflex, conjunctival injection, evidence of an open globe such as a corneal laceration, or a hypopyon (Figures 43.1 and 43.2). An ophthalmic ultrasound can also be helpful in showing vitritis but is not mandatory.

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Nov 11, 2022 | Posted by in EMERGENCY MEDICINE | Comments Off on Infectious and Inflammatory Retinal Diseases

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