Optic neuropathy as an initial manifestation of acute retinal necrosis caused by varicella zoster virus: a case report

BackgroundWe present the treatment and follow-up of a rare patient with acute retinal necrosis (ARN) with optic neuropathy as the first manifestation.Case presentationA 57-year-old male patient first presented with reduced vision and optic neuropathy in his right eye.After 20 days, the vision in the left eye decreased, and the slit-lamp examination showed no remarkable changes in the anterior segment. The right eye showed 2 + cells and flares in the anterior chamber. The iris texture was good, the pupils were round (light reflex), the crystalline lens was slightly opaque, and the vitreous was turbid. An anterior chamber paracentesis was performed to collect aqueous humor for polymerase chain reaction testing. The PCR test showed positive detection of VZV in the right eye, while the content of VZV in the left eye was lower than the reference value. Both eyes of the patient were successively diagnosed with acute retinal necrosis (ARN) due to VZV infection. The patient was treated with topical antiviral and anti-inflammatory eye medication, oral steroids, and general antiviral drugs. After three months, the vision and condition were relatively stable.ConclusionsClinicians should realize that accurate diagnosis and timely antiviral therapy are crucial for treating ARN.