Varicella-zoster virus acute retinal necrosis
What is Varicella-Zoster Virus Acute Retinal Necrosis
Varicella-zoster virus (VZV) acute retinal necrosis (ARN) syndrome is a rare, but vision-threatening ocular complication of varicella involving the retina, ciliary body, and other peripheral structures. It is caused by reactivation of latent VZV from the trigeminal or dorsal root ganglia, which results in a severe, necrotizing, necrotizing retinitis.
ARN is typically unilateral, but less often it presents as a bilateral disease. The classic presentation includes rapid onset of blurred vision, floaters, redness, pain, photopsia, and a deep grayish-violet retinitis that is sharply demarcated from healthy retina.
Symptoms of Varicella-Zoster Virus Acute Retinal Necrosis
The most common symptoms of VZV ARN are problems with vision including:
- Blurred vision
- Floaters
- Photopsia
- Redness
- Pain
- Significantly decreased vision
Treatment
Treatment typically involves a combination of systemic antiviral therapy, intravitreal injection of antiviral agents, and local retinal laser photocoagulation. Systemic antiviral therapy is usually the first-line treatment, and typically includes acyclovir, famciclovir, or valacyclovir. Intravitreal antiviral therapy is often used in conjunction with systemic treatment in order to achieve a higher virus-killing effect. For local retinal laser photocoagulation, laser spots are created in the areas of retinal necrosis in order to prevent the necrotic areas from spreading further. Surgery is rarely indicated, except in cases of retinal detachment.
Prevention
The best prevention of VZV ARN is prompt recognition and management of primary viremia. Patients at risk for VZV infection should be monitored for early signs and symptoms and should be tested as soon as possible to detect the virus. Patients who are immunocompromised, such as those receiving chemotherapy or long-term corticosteroid treatment, should be especially vigilant for symptoms of VZV infection.