Retinal periphlebitis (Eale’s disease). Central serous retinopathy
Retinal periphlebitis aka Eale’s disease and central serous retinopathy are examples of inflammatory diseases affecting the retina.
Retinal periphlebitis (Eale’s disease)
This is an idiopathic, inflammatory peripheral retinal vasculopathy which presents with recurrent vitreous and retinal haemorrhages. It is a bilateral disease typically affecting young males (20-30 years).
Aetiology: it is commonly associated with tuberculosis (seen as a hypersensitive reaction to tuberculoprotein).
The most common presenting symptoms are
- i. Sudden appearance of floaters (black spots) in front of the eye ii. Painless loss of vision due to vitreous haemorrhage. The haemorrhage usually clears up but recurrences are common.
The clinical course of Eale’s disease can be described in four stages:
- Inflammation: affect peripheral veins are congested and perivascular exudates and sheathing are seen along their surface.
- Ischaemia: there is obliteration of involved vessels and development of avascular areas in the periphery. This can be seen on fundus fluorescein angiography.
- Retinal neovascularization: abnormal fragile vessels develop at the junction of perfused and non-perfused retinal areas. Bleeding from these vessels leads to recurrent vitreous haemorrhage.
- Sequelae: during this stage, complications such as proliferative vitreoretinopathy, tractional retinal detachment and neovascular glaucoma develop.
Treatment:
- Treat the underlying cause of inflammation e.g. tuberculosis
- Systemic oral corticosteroids help to treat the active inflammation.
- Laser photocoagulation is indicated in the stage of neovascularization.
- Vitrectomy can be carried out in complicated cases.
Central Serous Retinopathy
This disease is characterized by a localised detachment of the sensory retina at the macula. This occurs secondary to a local defect in the retinal pigment epithelium. It is a typical example of macular oedema.
Aetiology:
It is caused by angiospasm and hyperpermeability which may be allergic or toxic in nature. This angiospasm and hyperpermeability leads to exudation from the parafoveal or choroidal capillaries.
Symptoms:
- i. Transient and sudden impairment of central vision or visual acuity.
- ii. A black patch can be seen in front of the patient’s eyes (positive scotoma) iii. Micropsia or metamorphopsia may be present.
Some signs such as a circular grey swelling about the size of the optic disc can be seen over the macular region. This is due to shallow detachment of the sensory macular retina.
Complications such as geographic atrophy of pigment epithelium and choriocapillaries, fibrovascular scar formation and tears in the retinal pigment epithelium ay occur.
Diagnosis:
Fluorescein angiography—It reveals leakage of dye through a defect in the Bruch’s membrane into the subretinal space.