BACKGROUND: Acute retinal necrosis (ARN) is a rare self-limiting ocular condition that can lead to severe visual impairment in an otherwise healthy patient. The etiology of ARN is the varicella zoster virus in older patients and the herpes simplex virus in younger patients. Patients usually present with ocular pain and blurred vision. The ocular sequelae can be complicated with retinal detachments or optic nerve swelling or atrophy. The clinical appearance, angiographic features, differential diagnosis and management are discussed.
CASE REPORT(S). A 57-year-old white male reported to the eye clinic with complaint of blurred vision accompanied by pain in the right eye for five days. A diagnosis of acute retinal necrosis was made based on the clinical appearance and laboratory confirmation of the varicella virus in the intraocular fluid. Vision deteriorated rapidly despite treatment with intravenous and oral acyclovir, as well as, oral steroids. The patient also developed a retinal detachment, which was walled off with laser photocoagulation to prevent further progression. Vision remained poor secondary to macular involvement. The left eye remains unaffected.
CONCLUSIONS. Painful visual loss displaying moderate to severe vitritis along with multifocal infiltrates that form confluent areas of retinal whitening in the periphery in an otherwise healthy individual should alert suspicion of acute retinal necrosis. Treatment with oral and IV anti-virals/steroids may hasten resolution of the inflammatory retinitis and protect the fellow eye. Maintenance oral anti-virals may prevent recurrences. Prognosis is dependent on the extent and severity of the retinitis, the formation of retinal detachments, optic nerve swelling, or vascular occlusive events. Only one third of affected eyes achieve better than 20/200 vision.