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A 26-year-old man with a blind spot in his left eye
Digital Journal of Ophthalmology 2013
Volume 19, Number 3
September 26, 2013
DOI: 10.5693/djo.03.2013.07.001
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Alfred White Jr, MD | USF Eye Institute, University of South Florida
Timothy Saunders, MD | USF Eye Institute, University of South Florida
Peter Reed Pavan, MD | USF Eye Institute, University of South Florida
Differential Diagnosis
Neuroretinitis with vitreous cells has a diverse differential diagnosis. Infectious sources that can present similarly include syphilis, Bartonella, Toxoplasma gondii, Toxocara, HIV, HSV, CMV, tuberculosis, Borreila burgdorferi, Leptospira interrogans, Rickettsia typhi, cysticercosis, and Aspergillus.(3,4) Inflammatory conditions, such as multiple sclerosis, sarcoidosis, and systemic lupus erythematosus, also have similar presentations. Neoplastic diseases, such as meningioma, glioma, central nervous system lymphoma, and infiltrative metastatic disease with leptomeningeal involvement should also be included in the differential diagnosis. Conditions such as myelinated nerve fiber layer, and optic disc drusen can be mistaken for neuroretinitis. Vascular diseases, including non-arteritic and arteritic anterior ischemic optic neuropathy, diabetic retinopathy, radiation retinopathy, and central retinal vein occlusion, also bear a resemblance when papillitis is present. True papilledema due to increased intracranial pressure, through its various mechanisms, should be included in the work-up.(5) Toxic causes, such as methanol, ethylene glycol, and ethambutol, are unlikely in the presence of vitreous cells.
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