Madison Area Lyme Support Group

PURPOSE OF REVIEW:

To explore and critically appraise the published data on the current and emerging treatment modalities for neuroretinitis.

RECENT FINDINGS:

The optimum treatment strategy for neuroretinitis due to Bartonella henselae in immunocompetent individuals is not clear and a matter of debate. The role of systemic corticosteroids in infectious neuroretinitis and the optimum immunosuppressive regimen for use in recurrent idiopathic neuroretinitis also remains ill defined. There is no class 1 evidence to support a specific treatment strategy for neuroretinitis. For uncomplicated B. henselae-associated neuroretinitis in immunocompetent patients, initiation of antibiotic and corticosteroid therapy remains controversial.

• In patients with severe vision loss and/or moderate to severe systemic symptoms, a 4- to 6-week regimen of doxycycline or azithromycin with rifampin may provide some benefit.
• The routine use of systemic corticosteroids in infectious neuroretinitis is not recommended.
• Targeted antimicrobial agents should be instituted in cases of neuroretinitis due to specific infectious etiologies (e.g., syphilis, Lyme disease, tuberculosis).
• Azathioprine may be beneficial in cases of recurrent idiopathic neuroretinitis.

There is a need for collaborative, multicenter prospective studies to provide definitive guidelines regarding the use of antibiotics and corticosteroids and to evaluate future therapies in infectious and recurrent idiopathic neuroretinitis.

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**Comment**

Bartonella is known to cause numerous eye issues.

https://madisonarealymesupportgroup.com/2019/04/08/case-series-bartonella-ocular-manifestations/

https://madisonarealymesupportgroup.com/2018/09/06/ocular-manifestations-of-bartonellosis/

https://madisonarealymesupportgroup.com/2017/10/23/opthalmic-manifestations-of-bartonella-infection/

https://madisonarealymesupportgroup.com/2017/07/21/bartonella-and-neuroretinitis/

https://madisonarealymesupportgroup.com/2018/07/10/bartonella-henselae-neuroretinitis-in-patients-without-cat-scratch/

https://madisonarealymesupportgroup.com/2016/01/03/bartonella-treatment/

Most Lyme literate doctors do not recommend systemic corticosteroids unless antimicrobials are used in tandem. If steroids are used alone they suppress the immune system allowing the infection(s) to worsen.