Neuroretinitis/Optic disc oedema with macular star (ODEMS)

Question 1

What is neuroretinitis?

Answer 1

optic neuritis + signs of retinal (usually macular) inflammation

Question 2

what causes neuroretinitis

Answer 2

• Idiopathic (more common in SG)
• Cat scratch fever (Bartonella) (majority of infectious neuroretinitis)
• Others: syphilis, TB, Lyme disease, mumps, leptospirosis, rocky mountain spotted fever, Toxoplasmosis, Toxocariasis, Histoplasmosis

Question 3

what are the symptoms of neuroretinitis?

Answer 3

Painless unilateral visual impairment (central vision), usually gradually worsening over a week

Question 4

what are the signs of neuroretinitis?

Answer 4

• VA is impaired to variable degree
• Decreased colour vision
• Papillitis associated with peripapillary and macular oedema
• A macular star typically appears as disc swelling settles (towards disc pallor); the macular star resolves with a return to normal or near-normal VA over 6-12 months

Question 5

what are the investigations done for neuroretinitis?

Answer 5

• OCT: Demonstrates subretinal and intraretinal fluid (inflammation of retinal nerve fibre layer).
• Blood tests: May include serology for Bartonella and other causes, according to clinical suspicion.

Question 6

what are the ddx for neuroretinitis?

Answer 6

hypertensive retinopathy, papilloedema, anterior ischaemic optic neuropathy (AION), diabetic papillopathy, etc, but many of these other disease processes are bilateral.