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Neuroretinitis: a tricky mimic
  1. Christian J Lueck1,2
  1. 1Department of Neurology, The Canberra Hospital, Canberra, ACT 2605 Australia
  2. 2Medical School, Australian National University, Canberra, ACT 2020, Australia
  1. Correspondence to Christian J Lueck, The Canberra Hospital – Neurology Canberra, Australian Capital Territory and Australian National University - Medical School Canberra, Australian Capital Territory, Australia; christian.lueck{at}

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Neuroretinitis is relatively rare. It refers to the triad of subacute visual loss, optic disc swelling and a macular star (figure 1), often in association with cells in the vitreous.1–4 An illustrative case is presented in this issue of Practical Neurology.5 The macular star typically takes 1–2 weeks to develop, meaning that it is usually not possible to make the diagnosis when the patient first presents. At that time, the condition may resemble, and be misdiagnosed as, idiopathic demyelinating optic neuritis (IDON) with the potential for inappropriate use of multiple sclerosis disease-modifying agents or, alternatively, failure to treat a preventable cause of visual loss. It is therefore important that neurologists are aware of this condition.6

Figure 1

Macular star. Reprinted with permission from Weerasinghe and Lueck.6

The radial arrangement of the hard exudates in a macular star arises from the anatomy of the outer plexiform layer of the retina, and not all macular stars are perfectly formed.5 The combination of optic disc oedema with a macular star2 can occur in conditions other than neuroretinitis, the most frequent being hypertensive retinopathy (see table 1). Most masqueraders …

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  • Contributors Sole contributor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed by Susan Mollan, Birmingham, UK.

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