Systemically have fever, headache, fatigue, nausea, vomiting, myalgia, skin rash, and arthralgia
Ocular manifestations include anterior uveitis, retinitis, nodular episcleritis.
Resembles HSV uveitis with diffuse KPs, iris pigment release, and elevated IOP
Rx as would for anterior uveitis. No rx proven for retinitis.
Often UNILATERAL, caused by roundworm Toxocara canis or Toxocara cati
Organisms grow in intestines and disseminate in body. Stool analysis low yield as reproduction does not occur in humans.
Pts present with unilateral decreased vision, photophobia, pain, floaters, strabismus, and leukocoria.
Leukocoria, localized granuloma, and peripheral granuloma, pars planitis
Diagnosis clinical with supportive ELISA
Rx with periocular or systemic steroids, laser to visible worm. Antihelminthic therapy not established.
Caused by nematode infection often in young, healthy patients.
Etiology due to Ancylostoma canium (dog hookwork), Toxocara canis, or Baylisascaris procyonis (racoon roundworm)
Characterized by insidious onset of unilateral visual loss from recurrent episodes of focal, multifocal, and diffuse inflammation of retina, RPE, and optic nerve. Early shows vitritis, optic disc edema, and multiple, focal, gray-white lesions in postequatorial fundus
Diagnosis is clinical and strongly supported by visualization of worm in subretinal space.
Rx with direct laser to worm or albendazole. Corticosteroids only transiently reduce inflammation.
Can mimic unilateral Retinitis Pigmentosa
Nontreponemal: SLE, leprosy, advanced age, IVDA, endocarditis, TB, vaccinations, mono, HIV, atypical pneumonia, malaria, pregnancy, rickettsial infections, lyme, leptospirosis
Treponemal: Other spirochetal disease, SLE, PBC, RA, leprosy, malaria, advanced age
Stage 1: Erythema chronicum migrans
Stage 2: Remote rash at site away from tick bite, oligoarthritis affecting large joints, meningitis, encephalitis, Bell's palsy
Stage 3: Chronic arthritis or neurologic sxs
Stage 1: Follicular conjunctivits
Stage 2: Uveitis (anterior, intermediate, or posterior). Intermediate is very common and vitritis often severe.
Stage 3: Keratitis, less common uveitis
Can also have multiple CN palsies
Mnemonic: FUK I have lyme disease (follicular conjunctivitis, uveitis, and keratitis in stage 1, 2, 3,)
Diagnose with ELISA then Western Blot
Rx with Doxy, ceftriaxone if CNS disease
A gram-neg spirochete contracted by contact with contaminated soil, water, tissues, or infected animals.
Systemically causes abrupt onset of fever, chills, myalgias, HA, vomiting, diarrhea. Weil disease causes renal and liver dysfunction.
Ocular: circumcorneal conjunctival hyperemia is earliest and most common sign. Can cause anterior or diffuse uveitis.
Diagnose with culture (difficult), ELISA, PCR, microagglutination test (gold standard),
R with IV penicillin if severe, doxy if mild/moderate
Favorable visual prognosis
Often in setting of previous trauma or surgery.
Caused by Pseudomonas, actinomyes, nocardia, myobacteria, fusarium, aspergillus, and staph/strep.
Sclera appears necrotic, thin, and avascular with inflammation at edges (usually at site of surgical wound of trauma)
Diagnose with cultures
Rx with topical, subconj, or systemic atbx.