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. 2015 Dec 14;39(6):266-270.
doi: 10.3109/01658107.2015.1092561. eCollection 2015 Dec.

Final Diagnosis in Patients Referred with a Diagnosis of Neuroretinitis

Rim Kahloun  1 , Imen Khairallah-Ksiaa  1 , Nesrine Abroug  1 , Anis Mahmoud  1 , Salim Ben Yahia  1 , Sonia Zaouali  1 , Bechir Jelliti  1 , Moncef Khairallah  1
Affiliations

Final Diagnosis in Patients Referred with a Diagnosis of Neuroretinitis

Rim Kahloun et al. Neuroophthalmology. .

Abstract

The purpose of this study was to determine final diagnosis of patients referred with a diagnosis of neuroretinitis. A retrospective study of 40 patients with optic disc oedema with macular star (ODOMS) referred with a diagnosis of neuroretinitis was conducted. The final diagnosis was neuroretinitis in 26 patients (65%), with most of these patients (96.1%) having unilateral involvement. Main underlying aetiologies included cat scratch disease (30.8%), rickettsiosis (19.2%), and idiopathic neuroretinitis (23.1%). The remaining 14 patients (35%) had ODOMS that had been mistaken for neuroretinitis. Of these patients, 42.8% were found to have a previously unknown malignant systemic hypertension in association with bilateral ODOMS. Neuroretinitis, usually unilateral, should be differentiated from other causes of unilateral or most often bilateral ODOMS that may masquerade as neuroretinitis, mainly malignant systemic hypertension. This is essential to avoid inappropriate work-up and management and subsequent potential visual or systemic morbidity.

Keywords: Cat scratch disease; macular star; neuroretinitis; optic disc oedema; rickettsiosis; systemic hypertension.

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Figures

FIGURE 1
FIGURE 1
Red-free fundus photograph of the left eye of a 34-year-old patient with cat scratch disease shows optic disc oedema with telangiectasic vessels and a macular star.
FIGURE 2
FIGURE 2
Fundus photograph of the left eye of a 35-year-old patient with rickettsial disease shows optic disc oedema and a complete macular star.
FIGURE 3
FIGURE 3
A 29-year-old otherwise healthy man was referred for suspicion of infectious neuroretinitis in both eyes. Fundus photographs (A, B) show arterial narrowing, multiple cotton-wool spots, and a partial macular star in both eyes, and superficial peripapillary retinal haemorrhages in the left eye. Physical examination revealed a previously unknown severe systemic hypertension.
FIGURE 4
FIGURE 4
Fundus photograph of the left eye of a 33-year-old patient with diabetic papillopathy mistaken for neuroretinitis. Note the presence of optic disc oedema, optic disc telangiectatic vessels, and a macular star associated with retinal hard exudates due to clinically significant macular oedema.
See this image and copyright information in PMC

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