Introduction: Retinal vasculitis is a sight-threatening condition characterized by inflammation of the retinal blood vessels. This article provides a comprehensive overview of retinal vasculitis, including its etiology, clinical manifestations, diagnostic evaluation, management strategies, and prognostic considerations.

Etiology: Retinal vasculitis can arise from various etiologies, including:

1. Autoimmune diseases (e.g., Behçet’s disease, systemic lupus erythematosus)
2. Infectious agents (e.g., tuberculosis, syphilis, viral retinitis)
3. Idiopathic or primary retinal vasculitis
4. Other systemic inflammatory conditions (e.g., sarcoidosis, Wegener’s granulomatosis)

Clinical Manifestations: Clinical manifestations of retinal vasculitis may vary depending on the underlying cause and the extent of retinal involvement. Common features include:

• Blurred vision and visual disturbances
• Floaters and photopsia
• Retinal hemorrhages and cotton-wool spots
• Vascular sheathing and exudates
• Neovascularization and macular edema
• Retinal ischemia and occlusive vasculopathy

Diagnostic Evaluation: Diagnosing retinal vasculitis requires a comprehensive ophthalmic evaluation, along with investigations such as:

• Fundus examination to assess retinal vascular changes and associated findings
• Fluorescein angiography (FA) to visualize vascular leakage, ischemia, and neovascularization
• Optical coherence tomography (OCT) to evaluate macular morphology and detect cystoid changes
• Laboratory tests, including complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and specific serological tests for infectious and autoimmune etiologies

Management Strategies: Management of retinal vasculitis aims to control inflammation, preserve vision, and prevent disease progression. Treatment modalities may include:

• Corticosteroids (topical, periocular, systemic) to suppress inflammation and reduce vasculitic activity
• Immunosuppressive agents (e.g., methotrexate, azathioprine, cyclosporine) for refractory or systemic cases
• Biologic agents (e.g., anti-tumor necrosis factor-alpha [TNF-α] agents) for autoimmune-mediated vasculitis
• Anti-VEGF therapy for managing neovascular complications and macular edema
• Laser photocoagulation or retinal photodynamic therapy (PDT) for ischemic and neovascular lesions

Prognostic Considerations: The prognosis of retinal vasculitis depends on various factors, including the underlying etiology, extent of retinal damage, and response to treatment. Early diagnosis and prompt intervention are crucial for preserving vision and preventing irreversible complications such as retinal ischemia, neovascularization, and retinal detachment.

Reference Sites:

1. National Eye Institute (NEI) – https://www.nei.nih.gov/
2. American Uveitis Society (AUS) – https://uveitissociety.org/
3. British Society for Immunology (BSI) – https://www.immunology.org/
4. American Academy of Ophthalmology (AAO) – https://www.aao.org/

This comprehensive overview aims to enhance understanding of retinal vasculitis among ophthalmologists, facilitating timely diagnosis, appropriate management, and optimal visual outcomes for affected patients. By integrating evidence-based practices and multidisciplinary approaches, clinicians can effectively address the challenges posed by retinal vasculitis and improve patient care and outcomes.