Retinal vasculitis refers to inflammation of the blood vessels within the retina, the light-sensitive tissue located at the back of the eye. When these blood vessels become inflamed, their ability to supply blood to the retina can be compromised, potentially leading to vision changes.
Primary Visual Symptoms
Individuals experiencing retinal vasculitis often notice changes in their vision, which begin without pain. A common initial symptom is painless blurring or decreased visual clarity, affecting the ability to see details sharply. This blurring may affect central vision, making it difficult to perform tasks like reading or recognizing faces.
Many people also report the appearance of “floaters” in their field of vision. These are described as small spots, specks, or web-like lines that drift across the sight, particularly noticeable against a bright background. Floaters occur when tiny clumps of cells or fibers within the vitreous gel, the clear substance filling the eye, cast shadows onto the retina.
Another symptom is the development of scotomas, which are blind spots or dark areas within the field of vision. These can vary in size and location, sometimes enlarging over time. Individuals may also experience flashes of light, distortions where straight lines appear wavy (metamorphopsia), or a reduced ability to distinguish colors.
While retinal vasculitis is generally painless, some individuals might experience eye pain or redness. Symptoms vary in severity, from mild disturbances to significant visual impairment. Any new or worsening visual changes warrant prompt eye care.
Associated Systemic Conditions
Retinal vasculitis is often a manifestation of an underlying condition affecting the entire body. Understanding this connection helps guide the overall approach to management.
One category of underlying causes includes autoimmune diseases, where the body’s immune system mistakenly attacks its own tissues. Examples include Behçet’s disease, sarcoidosis, systemic lupus erythematosus (SLE), rheumatoid arthritis, and multiple sclerosis.
Infections represent another group of potential causes for retinal vasculitis. Bacterial infections such as tuberculosis and syphilis can trigger inflammation in the retinal vessels. Certain viral infections (e.g., herpes simplex, varicella-zoster viruses), and parasitic infections like toxoplasmosis, can also lead to this condition.
In some instances, the cause of retinal vasculitis remains unknown, and these cases are termed idiopathic. Eales’ disease and idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) are examples falling into this category. Identifying any underlying systemic condition is a considerable part of addressing retinal vasculitis.
The Diagnostic Evaluation
Confirming a diagnosis of retinal vasculitis involves a comprehensive eye examination and specialized imaging tests. The process begins with a dilated fundus examination, where an eye doctor uses dilating eye drops to widen the pupil for a detailed view of the retina. During this examination, the doctor looks for specific signs such as perivascular infiltrates or white sheathing around the retinal vessels, which indicate inflammation.
Fluorescein angiography (FA) is a common imaging test. A dye is injected into an arm vein, traveling to the eye’s blood vessels. A camera captures images as the dye circulates, revealing areas where blood vessels are leaking, staining, or have reduced blood flow. This test helps determine the extent and pattern of vascular involvement.
Optical Coherence Tomography (OCT) is another imaging technique used to diagnose and monitor retinal vasculitis. This non-invasive scan provides detailed cross-sectional images of the retina, allowing for the detection of swelling, such as macular edema, or other structural changes that may affect vision.
Beyond eye-specific tests, blood tests are often ordered to investigate potential underlying systemic conditions. These laboratory tests help differentiate between infectious and non-infectious causes and can aid in identifying autoimmune diseases or other inflammatory disorders that might be contributing to the retinal vasculitis.
Long-Term Visual Complications
If retinal vasculitis is severe or not managed promptly, it can lead to several long-term visual complications that may permanently affect sight. One common issue is macular edema, which is swelling in the macula, the central part of the retina responsible for sharp, detailed vision. This swelling can significantly blur central vision.
Another serious complication is retinal ischemia, where inflammation causes blood vessel blockages, leading to a lack of blood flow and oxygen to parts of the retina. This can result in damage to retinal tissue and a reduction in visual function. Prolonged ischemia can also trigger the growth of new, fragile blood vessels, a process called neovascularization.
These new, abnormal vessels are prone to bleeding, potentially causing vitreous hemorrhage, which is bleeding into the clear gel that fills the eye, further obscuring vision. The growth of these vessels can also lead to the formation of scar tissue, which may pull on the retina and cause a retinal detachment. In severe cases, these complications can lead to permanent vision loss, underscoring the importance of early detection and appropriate management.