Re-exposure to cats or kittens is the major modifiable risk factor
Patient Discharge Instructions
copy discharge instructions
Diagnosis explanation
Cat scratch disease with eye nerve involvement (neuroretinitis)
Caused by Bartonella henselae bacteria from cat scratch or bite
Infection affects the optic nerve at the back of the eye
Causes temporary vision blurring and changes
Expected course with treatment
Most patients (80%) recover vision better than 20/40
Improvement typically seen over 4 to 6 weeks of treatment
The white star pattern (macular star) on eye exam resolves over weeks to months
Medication instructions
Doxycycline 100 mg twice daily for 4 to 6 weeks as prescribed
Take with full glass of water
Remain sitting or standing upright for 30 minutes after taking (prevents esophagitis)
Avoid dairy products, antacids, and calcium supplements within 2 hours of dose (reduces absorption)
Avoid prolonged sun exposure; use SPF 30+ sunscreen (photosensitivity risk)
If prescribed prednisone (steroid):
Take in the morning with food
Do not stop abruptly; taper as directed by your doctor
Monitor blood sugar if diabetic
If prescribed rifampin:
May turn urine, sweat, and tears orange-red; this is expected and harmless
Do not take with concurrent steroids unless specifically instructed
Activity and prevention
Cat and flea prevention measures
Apply flea control product to your cat as recommended by a veterinarian
Wash cat scratches or bites promptly with soap and water
Avoid rough play with kittens; they are more likely to carry the bacteria
Visual safety during recovery
No driving if vision is severely affected in either eye until cleared by ophthalmologist
Use caution on stairs and uneven surfaces if vision is impaired
Return to emergency department immediately for
Sudden worsening or new vision loss in either eye
Especially new involvement of the second eye
New onset severe headache, confusion, or seizure
May indicate spread of infection to the brain
High fever returning after starting antibiotics
Not improving within 48 to 72 hours of treatment
Abdominal pain or significant nausea/vomiting
May indicate liver or spleen involvement
New floaters, flashing lights, or a shadow or curtain in your vision
Retinal involvement or retinal detachment concern
Follow-up instructions
Ophthalmology appointment within 1 to 2 weeks
To check if the macular star has developed (may not be visible at first)
Visual acuity and nerve swelling monitoring
Second ophthalmology visit at 4 to 6 weeks
Treatment response assessment
Antibiotic completion confirmation
Blood test for Bartonella antibodies in 2 to 4 weeks if initial test was low or negative
Rising antibody levels confirm the diagnosis
References
Guidelines and key sources
Primary evidence sources
Shi J, Danesh-Meyer HV, Bhatti MT. Neuroretinitis: A Comprehensive Review on Aetiologies, Clinical Manifestations, and Treatment Options. Eye. 2025. PMID 39537838
Comprehensive review of neuroretinitis etiology and management
Abdelhakim A, Rasool N. Neuroretinitis: A Review. Current Opinion in Ophthalmology. 2018. PMID 30148725
Clinical review covering diagnosis and treatment
Reed JB, Scales DK, Wong MT, et al. Bartonella Henselae Neuroretinitis in Cat Scratch Disease. Ophthalmology. 1998. PMID 9499776
Foundational series establishing visual outcomes and treatment data
Cunningham ET, Koehler JE. Ocular Bartonellosis. American Journal of Ophthalmology. 2000. PMID 11020414
Definitive review of ocular manifestations and corticosteroid evidence
Infectious disease guidelines
IDSA guidelines and references
Stevens DL, Bisno AL, Chambers HF, et al. Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update. Clinical Infectious Diseases. 2014. PMID via academic.oup.com/cid/article-lookup/doi/10.1093/cid/ciu296
IDSA guidance on Bartonella including antibiotic recommendations
Benson C, Brooks J, Dhanireddy S, et al. Guidelines for Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. IDSA/OARAC 2025. clinicalinfo.hiv.gov
HIV-specific Bartonella management guidance
Biousse V, Newman NJ. Diagnosis and Clinical Features of Common Optic Neuropathies. Lancet Neurology. 2016. PMID 27839652
Optic neuropathy differential diagnosis framework
Supporting references
Epidemiology and pediatric sources
Sandoval AC, Reyes FT, Prado MA, et al. Cat-Scratch Disease in the Pediatric Population. Pediatric Infectious Disease Journal. 2020. PMID 32404788
Pediatric CSD series with serology performance data
Nawrocki CC, Max RJ, Marzec NS, Nelson CA. Atypical Manifestations of Cat-Scratch Disease, United States, 2005-2014. Emerging Infectious Diseases. 2020. PMID 32568056
National data on CSD atypical presentations
Suhler EB, Lauer AK, Rosenbaum JT. Prevalence of Serologic Evidence of Cat Scratch Disease in Patients With Neuroretinitis. Ophthalmology. 2000. PMID 10811077
Establishes CSD as most common infectious cause of neuroretinitis
Yakubovsky M, Kadar L, Katchman E, et al. Cat Scratch Disease Encephalitis. International Journal of Infectious Diseases. 2026. PMID 41544843
CSD encephalitis rate and seizure data
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.