Chorioretinitis and Optic Neuritis
Rhea V. Morgan, DVM, DACVIM (Small Animal), DACVO
BASIC INFORMATION
Description
Inflammation of the tissues of the back of the eye (choroid, retina)
is called chorioretinitis. The choroid is part of the uvea of the eye,
so inflammation of the choroid may be called posterior uveitis.
Involvement of the nerve leading from the eye to the brain is called
optic neuritis. These conditions may occur alone or together and
are inherently serious because they affect vision.
Causes
With the exception of trauma to the eye, these conditions are usu-
ally manifestations of a systemic or generalized problem. The
choroid and retina are commonly affected by other diseases within
the body, and optic neuritis may arise with certain disorders of the
brain. Numerous causes must be considered:
More than 25 different infections can cause this inflamma-
tion, including fungal, tick-borne, bacterial, viral, protozoal,
and parasitic infections. Some types occur more often in dogs,
whereas others are more common in cats.
In rare instances, the immune system may attack the uvea, and
other parts of the body may also be affected.
Tumors may arise within the eye or metastasize to the eye from
elsewhere in the body.
Hypertension (high blood pressure), anemia, kidney disease,
sugar diabetes, elevated blood protein levels, and other blood
disorders may be causes.
Clinical Signs
Inflammation confined to the back of the eye may not be visible
and may not be discovered until the animal is examined for other
signs of illness. Inflammation that also affects the front of the eye
can cause the eye to be red, cloudy, and painful (squinting). Vision
may be affected, resulting in pupils of different sizes. If both eyes
are inflamed, the animal may act blind. The onset of blindness can
be quite sudden (within days).
Diagnostic Tests
Diagnosis of these conditions can be difficult without specialized
instruments to examine the back of the eye. If the diagnosis cannot be
confirmed, your veterinarian may refer your pet to a veterinary oph-
thalmologist or neurologist for further evaluation. A complete physi-
cal examination is usually performed to search for any other changes
that may signify the presence of a generalized (systemic) problem.
Laboratory tests are frequently done to search for infections
and underlying causes. Chest and abdominal x-rays and an abdom-
inal ultrasound are sometimes recommended. If hypertension is
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suspected, blood pressure can be measured. In eyes that are cloudy
and cannot be examined well, an ultrasound may be performed.
If a brain disorder is suspected, computed tomography (CT scan)
or magnetic resonance imaging and a spinal tap may be recom-
mended. The cause of chorioretinitis and/or optic neuritis can be
difficult to find and may require numerous tests.
TREATMENT AND FOLLOW-UP
Treatment Options
Treatment involves administering medications for the eye problem
and for any underlying causes. Medications applied to the eye do not
reach the retina and choroid but topical anti-inflammatory drugs (usu-
ally steroids), pupil dilators/pain relievers (such as atropine), and anti-
biotics may be used for inflammation in the front part of the eye.
Once an underlying cause is determined, appropriate treat-
ment is started for that condition. Examples include antibiotics,
anti-fungal agents, drugs for hypertension and blood disorders,
and chemotherapy for certain tumors. Oral anti-inflammatory
agents can reach the retina, choroid, optic nerve, and brain, but
the administration of steroids is often delayed until infectious dis-
eases are ruled out and a specific cause is determined.
Removal of the eye may be recommended in cases of sus-
pected intraocular tumors, blind eyes that remain painful, eyes that
develop unresponsive glaucoma, or concern that an infection may
persist in the eye and spread to other parts of the body (especially
certain fungal infections).
Follow-up Care
Chorioretinitis and optic neuritis often indicate the presence of
a serious underlying disease. If treatable, these diseases usually
require prolonged therapy (months), periodic recheck visits, and
careful monitoring. Certain laboratory tests may be repeated to
monitor for side effects associated with the oral drugs used to treat
these conditions.
Report any worsening of signs, particularly the onset of pain
(squinting) or decreased vision, to your veterinarian immediately.
Prognosis
Whether chorioretinitis or optic neuritis will resolve often depends
on the underlying cause, the severity of the inflammation, and the
diligence of the treatments. Many cases improve with adequate
therapy, but permanent scarring within the retina may result in
blindness. Some forms of optic neuritis improve with treatment but
are not cured, so therapy must be continued for the life of the ani-
mal. Some of the causes of these conditions are life-threatening.