Treatment Strategies for Neuroretinitis: Current Options and Emerging Therapies

  • Aaron M. Fairbanks
  • Matthew R. Starr
  • John J. Chen
  • M. Tariq BhattiEmail author
Neurologic Ophthalmology and Otology (R Shin and D Gold, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Neurologic Ophthalmology and Otology


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.


Neuroretinitis Bartonella Disc edema Macular star Cat scratch optic neuropathy 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

Dr. Bhatti participated in the following two studies that involved human subjects: Schmalfuss IM, Dean CW, Sistrom C, Bhatti MT. Optic neuropathy secondary to cat scratch disease: distinguishing MR imaging features from other types of optic neuropathies. AJNR Am J Neuroradiol. 2005;26 (6):1310–6; Chi SL, Stinnett S, Eggenberger E, Foroozan R, Golnik K, Lee MS, et al. Clinical characteristics in 53 patients with cat scratch optic neuropathy. Ophthalmology. 2012;119 (1):183–7.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Aaron M. Fairbanks
    • 1
  • Matthew R. Starr
    • 1
  • John J. Chen
    • 1
    • 2
  • M. Tariq Bhatti
    • 1
    • 2
    Email author
  1. 1.Department of OphthalmologyMayo ClinicRochesterUSA
  2. 2.Department of NeurologyMayo ClinicRochesterUSA

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