CLINICAL VIEW  h  OPHTHALMOLOGY  h  PEER REVIEWED

Chorioretinitis
David A. Wilkie, DVM, MS, DACVO
The Ohio State University

1 d Active feline chorioretinitis

and optic neuritis

secondary to systemic
cryptococcosis. Multifocal
areas of subretinal and
peripapillary edema
elevate the retina and blur
the underlying tapetum.

Chorioretinitis, or posterior hematogenously disseminated disease

uveitis, refers to inflammation of (eg, neoplasia, bacteremia, viremia, BEFORE
tick-borne disease, disseminated mycosis, YOUR EYES
the choroid and retina. Because parasitism, algal infection, protozoal
these posterior ophthalmic infection), and immune disease (eg, Watch a video of
uveodermatologic syndrome).1–9 Whereas active chorioretinitis
tissues are so intimately secondary to
chorioretinitis is most often bilateral,
associated, it is difficult to affect unilateral disease can occur and does not
disseminated
1 without affecting the other, and cryptococcosis as
preclude systemic disease.
seen by indirect
inflammatory disease of either ophthalmoscopy
Examination of the posterior segment of
results in chorioretinitis. at brief.vet/
the eye is indicated in animals with vision chorioretinitis
disturbance, when anterior uveitis is
The choroid is the posterior aspect of the present, in cases of known systemic
uvea or vascular tunic; it contains blood disease, and in patients with systemic
vessels, melanin, and, dorsally, the abnormalities of unknown cause as in
tapetum. The choroid supplies nutrition fever of unknown origin.
and removes waste material from the
retina; provides a cooling function, Active chorioretinitis is typically an
helping to dissipate heat generated by the ocular manifestation of a systemic
visual process; and facilitates vision in disease with a hematogenous cause.
dim light. To perform these functions, Baseline data should include a complete
the choroid has a tremendous blood flow, history, including travel history and
far more than that simply required for vaccination status, as well as a physical
oxygenation. Although this ensures the examination, CBC, serum chemistry
health of the retina, it also results in profile, urinalysis, diagnostic testing for
significant risk to the retina and choroid relevant infectious diseases, thoracic and
from vascular abnormalities (eg, hyper- abdominal imaging, and cytology.
tension, hyperviscosity, vasculitis),

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2 3 4
d Active
canine chorioretinitis dA
 ctive feline chorioretinitis dA
 ctive feline chorioretinitis

secondary to systemic secondary to systemic secondary to feline

cryptococcosis. The retina is blastomycosis. The dark infectious peritonitis. The
elevated by large areas of areas are the result of large retinal vessels appear
exudate that obscures the pyogranulomatous dilated and elevated by
underlying tapetum. choroidal infiltrates, and the the underlying exudate
perilesional gray areas are that alters the tapetal
retinal folds and wrinkles coloration.
secondary to edema and
retinal elevation.

5 6 7
d Active canine chorio- dP
 erivascular exudate or dC
 omplete retinal

retinitis secondary to cuffing involving a large detachment with

lymphosarcoma. Retinal, venule in a cat with active subretinal exudate as
peripapillary, and feline infectious peritonitis. a result of choroiditis
perivascular edema in a dog with active
are noted. uveodermatologic
syndrome.

36    cliniciansbrief.com    September 2015

 8 9 10
d The same eye in Figure 7 d Following immuno- dA
 large, focal

following immuno- suppressive therapy, chorioretinal scar

suppressive therapy and depigmentation and following an episode
retinal reattachment. pigment clumping are of chorioretinitis of
Multifocal tapetal seen in the nontapetal unknown cause.
hyperreflectivity and fundus in Figure 7.
hyperpigmentation are
noted.

Given the predilection for chorioretinitis in The eyes should

many systemic diseases, a dilated fundic be examined in
examination should also be a routine part of a dark room
the physical examination in animals with fever
using an indirect,
of unknown origin and when disseminated
direct, or PanOptic
neoplasia, mycosis, vasculitis, tick-borne
diseases, or similar conditions are considered
ophthalmoscope.
as possible differentials.

To examine the posterior aspect of the eye, the

11
pupil must first be dilated using a short-acting
mydriatic, such as 1% tropicamide. The eyes
should be examined in a dark room using an
indirect, direct, or PanOptic ophthalmoscope
d Tapetal necrosis, extensive

depigmentation, optic (WelchAllyn.com). The veterinarian should be

nerve pallor and retinal familiar with normal posterior segment
vascular attenuation are variations associated with species, coat, eye
seen as results of previous color, and age of the animal. An accurate
severe immune-mediated fundic examination allows direct, noninvasive
chorioretinitis. visualization of the arteries, venules, capillar-
ies, and central nervous system.

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Clinical Signs identified first. The safest nonspecific treat-

Chorioretinitis appears clinically as a color ment option pending diagnosis is administra-
change or loss of clarity of tissues on fundic tion of systemic nonsteroidal antiinflammato-
examination. With active chorioretinitis, the ries (NSAIDs) while test results are pending.
addition of fluid, protein, and cells within the Systemic corticosteroids should be adminis-
retina and subretinal tissues will obscure the tered only after infectious causes have been
tapetum or pigment of the choroid (hypore- ruled out or are being appropriately treated. If
flective) and may elevate or detach the retina indicated, the dose of systemic corticosteroids
and blur the image. Vascular involvement may range from antiinflammatory to immu-
may result in perivascular cuffing, vasculitis, nosuppressive, depending on cause. If the
hemorrhage, and exudate (Figures 1–7). With cause is immune-mediated, then additional
active chorioretinitis, anterior segment immunosuppressive therapy with azathio-
involvement is common, resulting in aqueous prine, cyclosporine, or other similar medica-
flare, miosis, hypopyon, keratic precipitates, tions may be required. If there is concurrent
cataract, corneal edema, and intraocular anterior uveitis, then topical corticosteroids,
pressure (IOP) changes. With chronicity, NSAIDs, and 1% atropine may also be
IOP = intraocular
pressure chorioretinitis leads to focal or diffuse retinal indicated. With anterior uveitis, determina-
degeneration, tapetal hyperreflectivity, tion and monitoring of IOP is also indicated.
depigmentation, hyperpigmentation, and
vascular attenuation (Figures 8–11). The sequelae of chorioretinitis include retinal
detachment, retinal degeneration, blindness,
Treatment phthisis bulbi, cataract, glaucoma, vitreal
Although treatment of chorioretinitis requires degeneration, optic nerve atrophy, and loss of
systemic medication, its cause must be the eye. n

References 6. Chavkin MJ, Lappin,MR, Powell CC, Roberts SM.

Seroepidemiologic and clinical observations of 93 cases of
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uveitis: 75 cases (1994-1999). Vet Ophthalmol. 2000;3(4):241-246.
7. Gelatt KN. Essentials of Veterinary Ophthalmology. 3rd ed. Ames,
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dogs: 102 cases (1989-2000). Vet Ophthalmol. 2002;5(2):93-98.
8. Narfstrom K, Petersen-Jones S. Diseases of the canine ocular
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1992;201(7):1005-1009. 1392.
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