Retinitis physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
Physical signs associated with retinitis will vary according to the underlying condition responsible for the disease. Genetic defects will result in a genetic disorder known as Retinitis pigmentosa. The presentation of this disorder is primarily visible in the degradation as well as degeneration of cone and rod cells. Infectious agents will present physical manifestations according to the underlying cause of infection. These clinical manifestations will range for yellowish infiltrates to inflammation and lesions localized to specific areas of the eye. | Physical signs associated with retinitis will vary according to the underlying condition responsible for the disease. [[Genetic defects]] will result in a [[genetic disorder]] known as Retinitis pigmentosa. The presentation of this [[disorder]] is primarily visible in the [[degradation]] as well as degeneration of [[Cone cells|cone and rod cells]]. [[Infectious agents]] will present [[Symptoms and Signs|physical manifestations]] according to the underlying cause of infection. These [[Symptoms and Signs|clinical manifestations]] will range for yellowish infiltrates to [[inflammation]] and [[lesions]] localized to specific areas of the eye. | ||
==Physical Examination== | ==Physical Examination== | ||
The physical signs associated with retinitis are specific to the underlying cause of the disease. There are two distinct causes of retinitis, genetic disorders and infectious agents. Genetic disorders are commonly linked to physical degeneration. Degradation of cones and rod cells will serve as physical indicators of disease progression. Infectious agents are classified as | The physical signs associated with retinitis are specific to the underlying cause of the disease. There are two distinct causes of retinitis, [[genetic disorders]] and [[infectious agents]]. [[Genetic disorders]] are commonly linked to [[Degeneration|physical degeneration]]. [[Degradation]] of [[Cone cell|cones]] and [[Rod cell|rod cells]] will serve as physical [[Indicator|indicators]] of disease progression. [[Infectious agents]] are classified as [[Parasitic|parasitic,]] [[fungal]] or [[Bacterial|bacterial.]] [[Fungal|Fungal agents]] are associated with the presence of circumscribed [[lesions]], with potentially visible [[hyphae]] or yellowish infiltrates. [[Bacterial infections]] may be associated with retinal [[hemorrhaging]] as well as lesions in previously scarred areas. | ||
==Genetic== | ==Genetic== | ||
===Retinitis Pigmentosa=== | ===Retinitis Pigmentosa=== | ||
*Cone or rod dystrophy | *[[Cone-rod dystrophy|Cone or rod dystrophy]] | ||
*Rod cell degeneration<ref name="US GEN">Retinitis Pigmentosa. U.S. National Library of Medicine. https://www.genome.gov/13514348 </ref> | *[[Rod cells|Rod cell degeneration]]<ref name="US GEN">Retinitis Pigmentosa. U.S. National Library of Medicine. https://www.genome.gov/13514348 </ref> | ||
==Infectious Agents== | ==Infectious Agents== | ||
===Cytomegalovirus=== | ===Cytomegalovirus=== | ||
*Physical evidence of a cytomegalovirus presence in one of both eyes will generally clinical present in the form of lesions, adjacent retinal vessels. | *Physical evidence of a [[Cytomegalovirus (patient information)|cytomegalovirus]] presence in one of both eyes will generally clinical present in the form of [[lesions]], adjacent [[Retinal vessel occlusion|retinal vessels]]. | ||
*These lesions may impinge upon the fovea and the optic nerve. Furthermore they are usually discovered in close proximity to both. | *These [[lesions]] may impinge upon the [[fovea]] and the [[optic nerve]]. Furthermore they are usually discovered in close proximity to both. | ||
*Further extending | *Further extending [[lesions]] may be present in close proximity to the vortex veins as well as the [[ora serrata]].<ref name="ret phys">Infectious Retinitis: A Review. YACHNA AHUJA, MD · STEVEN M. COUCH, MD · RAYMUND R. RAZONABLE, MD · SOPHIE J. BAKRI, MD. http://www.retinalphysician.com/articleviewer.aspx?articleID=102293. Accessed April 13, 2016. </ref> | ||
===Tuberculosis=== | ===Tuberculosis=== | ||
*Caseating granulomas | *[[Granulomas|Caseating granulomas]] | ||
*Multiple choroidal tubercles- small grayish nodules located on the posterior pole of the eye | *Multiple [[choroidal]] tubercles- small grayish [[nodules]] located on the posterior pole of the eye | ||
*Yellow necrotizing granulomas<ref name="ret phys">Infectious Retinitis: A Review. YACHNA AHUJA, MD · STEVEN M. COUCH, MD · RAYMUND R. RAZONABLE, MD · SOPHIE J. BAKRI, MD. http://www.retinalphysician.com/articleviewer.aspx?articleID=102293. Accessed April 13, 2016. </ref> | *Yellow [[Necrotizing|necrotizing granulomas]]<ref name="ret phys">Infectious Retinitis: A Review. YACHNA AHUJA, MD · STEVEN M. COUCH, MD · RAYMUND R. RAZONABLE, MD · SOPHIE J. BAKRI, MD. http://www.retinalphysician.com/articleviewer.aspx?articleID=102293. Accessed April 13, 2016. </ref> | ||
===Fungal=== | ===Fungal=== | ||
====''Candida albicans''==== | ====''Candida albicans''==== | ||
*Visibly hazy vitreous | *Visibly hazy [[vitreous]] | ||
*White circumscribed lesions<ref name="ret phys">Infectious Retinitis: A Review. YACHNA AHUJA, MD · STEVEN M. COUCH, MD · RAYMUND R. RAZONABLE, MD · SOPHIE J. BAKRI, MD. http://www.retinalphysician.com/articleviewer.aspx?articleID=102293. Accessed April 13, 2016. </ref> | *White circumscribed lesions<ref name="ret phys">Infectious Retinitis: A Review. YACHNA AHUJA, MD · STEVEN M. COUCH, MD · RAYMUND R. RAZONABLE, MD · SOPHIE J. BAKRI, MD. http://www.retinalphysician.com/articleviewer.aspx?articleID=102293. Accessed April 13, 2016. </ref> | ||
| Line 35: | Line 35: | ||
*Yellow subretinal infiltrates | *Yellow subretinal infiltrates | ||
*Retinal infiltrates | *Retinal infiltrates | ||
*Fungal hyphae are located throughout the eye - suggestive of pulmonary involvement<ref name="ret phys">Infectious Retinitis: A Review. YACHNA AHUJA, MD · STEVEN M. COUCH, MD · RAYMUND R. RAZONABLE, MD · SOPHIE J. BAKRI, MD. http://www.retinalphysician.com/articleviewer.aspx?articleID=102293. Accessed April 13, 2016. </ref> | *[[Hyphae|Fungal hyphae]] are located throughout the eye - suggestive of pulmonary involvement<ref name="ret phys">Infectious Retinitis: A Review. YACHNA AHUJA, MD · STEVEN M. COUCH, MD · RAYMUND R. RAZONABLE, MD · SOPHIE J. BAKRI, MD. http://www.retinalphysician.com/articleviewer.aspx?articleID=102293. Accessed April 13, 2016. </ref> | ||
====''Cryptococcus neoformans''==== | ====''Cryptococcus neoformans''==== | ||
*Yellowish-white lesions located on the fundus of the eye | *Yellowish-white lesions located on the [[fundus]] of the eye | ||
*Mutton-fat keratic precipitates<ref name="ret phys">Infectious Retinitis: A Review. YACHNA AHUJA, MD · STEVEN M. COUCH, MD · RAYMUND R. RAZONABLE, MD · SOPHIE J. BAKRI, MD. http://www.retinalphysician.com/articleviewer.aspx?articleID=102293. Accessed April 13, 2016. </ref> | *Mutton-fat keratic [[precipitates]]<ref name="ret phys">Infectious Retinitis: A Review. YACHNA AHUJA, MD · STEVEN M. COUCH, MD · RAYMUND R. RAZONABLE, MD · SOPHIE J. BAKRI, MD. http://www.retinalphysician.com/articleviewer.aspx?articleID=102293. Accessed April 13, 2016. </ref> | ||
===Toxoplasmosis=== | ===Toxoplasmosis=== | ||
| Line 46: | Line 46: | ||
===Syphilis=== | ===Syphilis=== | ||
*Hemorrhagic areas | *[[Bleeding (Excessive)|Hemorrhagic]] areas | ||
*Flare visible in anterior and posterior portions<ref name="ret phys">Infectious Retinitis: A Review. YACHNA AHUJA, MD · STEVEN M. COUCH, MD · RAYMUND R. RAZONABLE, MD · SOPHIE J. BAKRI, MD. http://www.retinalphysician.com/articleviewer.aspx?articleID=102293. Accessed April 13, 2016. </ref> | *Flare visible in anterior and posterior portions<ref name="ret phys">Infectious Retinitis: A Review. YACHNA AHUJA, MD · STEVEN M. COUCH, MD · RAYMUND R. RAZONABLE, MD · SOPHIE J. BAKRI, MD. http://www.retinalphysician.com/articleviewer.aspx?articleID=102293. Accessed April 13, 2016. </ref> | ||
Revision as of 19:29, 19 April 2016
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Overview
Physical signs associated with retinitis will vary according to the underlying condition responsible for the disease. Genetic defects will result in a genetic disorder known as Retinitis pigmentosa. The presentation of this disorder is primarily visible in the degradation as well as degeneration of cone and rod cells. Infectious agents will present physical manifestations according to the underlying cause of infection. These clinical manifestations will range for yellowish infiltrates to inflammation and lesions localized to specific areas of the eye.
Physical Examination
The physical signs associated with retinitis are specific to the underlying cause of the disease. There are two distinct causes of retinitis, genetic disorders and infectious agents. Genetic disorders are commonly linked to physical degeneration. Degradation of cones and rod cells will serve as physical indicators of disease progression. Infectious agents are classified as parasitic, fungal or bacterial. Fungal agents are associated with the presence of circumscribed lesions, with potentially visible hyphae or yellowish infiltrates. Bacterial infections may be associated with retinal hemorrhaging as well as lesions in previously scarred areas.
Genetic
Retinitis Pigmentosa
Infectious Agents
Cytomegalovirus
- Physical evidence of a cytomegalovirus presence in one of both eyes will generally clinical present in the form of lesions, adjacent retinal vessels.
- These lesions may impinge upon the fovea and the optic nerve. Furthermore they are usually discovered in close proximity to both.
- Further extending lesions may be present in close proximity to the vortex veins as well as the ora serrata.[2]
Tuberculosis
- Caseating granulomas
- Multiple choroidal tubercles- small grayish nodules located on the posterior pole of the eye
- Yellow necrotizing granulomas[2]
Fungal
Candida albicans
Aspergillus fumigatus
- Yellow subretinal infiltrates
- Retinal infiltrates
- Fungal hyphae are located throughout the eye - suggestive of pulmonary involvement[2]
Cryptococcus neoformans
- Yellowish-white lesions located on the fundus of the eye
- Mutton-fat keratic precipitates[2]
Toxoplasmosis
- Localized areas of infiltrate
- Active lesions are adjacent to initial scarring[2]
Syphilis
- Hemorrhagic areas
- Flare visible in anterior and posterior portions[2]
References
- ↑ Retinitis Pigmentosa. U.S. National Library of Medicine. https://www.genome.gov/13514348
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Infectious Retinitis: A Review. YACHNA AHUJA, MD · STEVEN M. COUCH, MD · RAYMUND R. RAZONABLE, MD · SOPHIE J. BAKRI, MD. http://www.retinalphysician.com/articleviewer.aspx?articleID=102293. Accessed April 13, 2016.