TABLE 7-4-1 -- POSTERIOR SEGMENT FINDINGS IN EBV, HTLV-1, INFLUENZA A, MEASLES, AND RUBELLA VIRAL

INFECTIONS
Vascula C!a"#$s R$%&"al C!a"#$s R$%&"al P&#'$"% E(&%!$l&u' C!a"#$s O(%&c N$)$ C!a"#$s
EBV Punched-out areas
HTLV-1 Gray-white granular
deposits
Retinitis pigmentosa-like ptic neuritis
!n"luen#
a $
%hiny dots at termination o"
capillaries%clerotic
&asculature
'acular edema (arkened
macular area %mall retinal
hemorrhages
ptic neuritis
'easles $ttenuated &essels Retinal edema%tellate macular
lesions
(epigmented areas%alt-and-pepper
changes
ptic neuritis
%%PE 'acular edema)hite retinal
in"iltrates%erous detachments
(epigmented areas ptic neuritis
Ru*ella %erous detachments %alt-and-pepper changes
EBV, Epstein-Barr virus; HTLV-1, human T-cell lymphotropic virus type 1; SSPE, subacute sclerosing panencephalitis+
'E$%LE% V!R,%
!-TR(,.T!-
The measles &irus is another R-$ &irus classi"ied as a paramy/o&irus+ !n"ection with
the &irus is usually sel"-limited *ut can *e associated with su*acute sclerosing
panencephalitis 0%%PE1+
EP!(E'!LG23P$THGE-E%!%
The &irus is trans"erred *y nasopharyngeal secretions to the respiratory tract or
con4uncti&a o" suscepti*le 0rentan1 patients+ The &irus is highly contagious and is
typically contracted in childhood+ .ongenital in"ections can occur+ Prenatal
transmission in the "irst trimester may cause a*ortion5 in"ection later may result in
premature *irth or mal"ormations such as cardiomyopathy6 cataract6 dea"ness 0tuli16
and pigmentary retinopathy+
.,L$R '$-!7E%T$T!-%
The ocular mani"estations o" congenital in"ection include cataract and pigmentary
retinopathy+
819:
The most common ocular mani"estations o" ac;uired in"ection are a
sel"-limited keratitis or con4uncti&itis+ R$%&"*(a%!+ ca" *ccu ,&%! ac-u&$.
'$asl$s &"/$c%&*"s0 (uring the acute stages o" retinal in&ol&ement6 the "undus &essels
may appear attenuated 0menipis6 melemah1+ There may *e di""use retinal edema
associated with optic disc swelling6 small hemorrhages6 and stellate macular lesions+
!rregular6 "lat6 depigmented areas may also appear with some decline 0turun6 merosot6
menolak1 in &ision+ $s the retinopathy resol&es6 a secondary pigment retinopathy with
a salt-and-pepper 0lada6 merica1 appearance may occur 0see Ta*le <-=-1 1+ Retinal
"indings associated with %%PE include macular edema6 pigment epithelial
a*normalities6 choroiditis6 whitish retinal in"iltrates6 s$*us 'acula .$%ac!'$"%s,
a$as */ $%&"al .$(&#'$"%a%&*"6 and optic neuritis+
81>: 81<: 81?:
'acular retinitis may
occur "irst and then the neurological "inding o" %%PE may result+ Early recognition
may allow earlier serological testing "or %%PE and allow an earlier diagnosis o" this
disease+
81@:
(!$G-%!% $-( $-.!LL$R2 TE%T!-G
7luorescein angiography may demonstrate a .&//us$ l$a1a#$ associated with retinal
edema or increased transmission o" choroidal "luorescence related to the pigment
epithelial disease+ There may *e &ascular occlusions6 retinal pigment epithelial
distur*ances 0kacau6 rusuh6 gangguan16 and cystic areas o" hyper"luorescence+
%erological tests "or measles &irus include compliment "i/ation6 en#yme
immunoassay6 immuno"luorescence6 and the hemagglutination inhi*ition test+
81?:
!n
addition6 P.R techni;ues may *e used "or detecting &iral R-$+
8AB:
(!77ERE-T!$L (!$G-%!%
The di""erential diagnosis o" measles retinopathy includes central serous
chorioretinopathy6 VCH disease6 in"luen#a $ retinitis6 to/oplasmic retinal choroiditis6
and retinitis pigmentosa+
P$THLG2
Histological specimens "rom uncomplicated measles cases are rare6 *ut specimens
ha&e *een documented in patients who ha&e su""ered "rom %%PE+ H&s%*l*#&call+,
%!$$ a$ a$as */ /*cal $%&"al "$c*s&s ,&%! &")as&*" */ (&#'$"%-la.$"
'ac*(!a#$s0 The retinal pigment epithelium may show patchy areas o" loss6 *ut the
choroid may appear normal+ !ntranuclear inclusions ca n *e seen in the nuclear layers
o" the retina+
81?:
TRE$T'E-T
-o treatment is necessary "or uncomplicated measles in"ections+ 'easles retinopathy
may result &" %!$ *"s$% */ acu%$ 2l&"."$ss a /$, ,$$1s /*ll*,&"# %!$ '$asl$s as!
a". &" #$"$al $s*l)&"# *)$ %!$ /*ll*,&"# '*"%!s0 N* %!$a(+ /* '$asl$s-
$la%$. $%&"*(a%!+ $3&s%s0
R,BELL$ V!R,%
The ophthalmic mani"estations o" ru*ella &irus are similar to those o" measles &irus
in"ections6 a". 2*%! ca" 2$ s$$" &" c*"#$"&%al a". ac-u&$. /*'s0 The congenital
ru*ella retinitis may present as a salt-and-pepper "undus appearance 0 7ig+ <-=-= 1+
Ac-u&$. u2$lla 2$#&"s ,&%! a class&cal as! a". 'ala&s$0 phthalmic
mani"estations include con4uncti&itis6 keratitis6 and iritis+ $ retinitis may appear and
can *e associated with e/udati&e detachments o" the retina and retinal pigment
epithelium+
8A1: 8AA:

7ig+ <-=-= Ru2$lla $%&"*(a%!+0 .lassic salt-and-pepper appearance o" the "undus is
seen in this case o" congenital ru*ella retinopathy+ 0.ourtesy o" George %+ -o&alis6
'(+1