University of Iowa Health Care

Ophthalmology and Visual Sciences

EyeRounds.org

Neuroretinitis

Category: Retina

Neuroretinitis 1

Contributor: Morgan Bertsch, BS and Tyler B.S. Risma, MD

Posted May 11, 2017

Patient presented with sudden onset decreased vision in his left eye. Fundus photos show the progression of macular star at presentation (Figure 1), 1 week later (Figure 2), and three weeks later (Figure 3). Ocular Coherence Tomography at these same visits shows significant outer retinal fluid in the nasal macula reaching the fovea center. The OCTs show gradual resolution of the intraretinal fluid and deposition of hyper-reflective material in the outer plexiform layer at the fovea, called the nerve fiber layer of Henle, and fluid here gives the classic appearance of a "macular star". The patient was serum positive for Bartonella henselae (Cat Scratch Disease).

Figure 1: Fundus photo and OCT on day 1 Figure 1: Fundus photo and OCT on day 1

Figure 1: Fundus photo and OCT on day 1

Figure 2: Fundus photo and OCT on day 7 Figure 2: Fundus photo and OCT on day 7

Figure 2: Fundus photo and OCT on day 7

Figure 3. Fundus photo and OCT on day 21 Figure 3. Fundus photo and OCT on day 21

Figure 3: Fundus photo and OCT on day 21


Neuroretinitis 2: Bartonella Neuroretinitis

Contributor: Jeffrey Welder, MD
01/24/2014

34-year-old female diagnosed with Bartonella neuroretinitis and cilioretinal artery occlusion of the left eye. She presented with a "gray spot" in her vision. Exam revealed an RAPD OS. Photos demonstrate appearance on presentation, 1 week, 3 weeks, 4 weeks, and 8 weeks after presentation. Patient was treated with oral Azithromycin at 5 weeks after presentation when positive bartonella serology returned.

Photo sequence:

Initial presentation

1 week after being treated with oral Azithromycin: Bartonella neuroretinitis and cilioretinal artery occlusion of the left eye


Week 1

1 week after being treated with oral Azithromycin: Bartonella neuroretinitis and cilioretinal artery occlusion of the left eye


Week 3

3 weeks after being treated with oral Azithromycin: Bartonella neuroretinitis and cilioretinal artery occlusion of the left eye


Week 4

Bartonella neuroretinitis and cilioretinal artery occlusion of the left eye


Week 8

8 weeks after being treated with oral Azithromycin: Bartonella neuroretinitis and cilioretinal artery occlusion of the left eye


Neuroretinitis 3

Contributor: Justin Risma, MD 

Posted 08/29/2012

Dilated exam revealed disc edema and a macular star (hard exudates arranged in a radial pattern due to the alignment of fibers in the outer plexiform layer, or Henle's layer).

 

Image Comments:

17-year-old male with painless central vision loss in the left eye. Dilated exam revealed disc edema and a macular star (hard exudates arranged in a radial pattern due to the alignment of fibers in the outer plexiform layer, or Henle's layer).


Neuroretinitis 4

Contributor: James M. Coombs, MD

Posted 02/08/2008

43-year-old female with acute loss of vision in the right eye. Infectious/inflammatory work-up negative

43-year-old female with acute loss of vision in the right eye. Infectious/inflammatory work-up negative

2 months later after a course of oral steroids

2 months later after a course of oral steroids


Neuroretinitis 5

Contributor: Andrew Doan, MD, PhD

Posted 02/08/2008

Patient with unilateral vision loss in the left eye. Marked disc swelling with macular star figure. Serum positive for bartonella henselae (Cat Scratch Disease).

Patient with unilateral vision loss in the left eye. Marked disc swelling with macular star figure. Serum positive for bartonella henselae (Cat Scratch Disease).


See related cases:

Cat-Scratch neuroretinitis (Ocular bartonellosis)

Recurrent Neuroretintitis

Diffuse Unilateral Subacute Neuroretinitis (DUSN)


No one may use these photographs for financial gain without written authorization from the contributor.

Creative Commons License
Ophthalmic Atlas Images by EyeRounds.org, The University of Iowa are licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.

last updated: 05/11/2017
Share this page: