Acute retinal necrosis

Background

• Definition:
  • Well-demarcated retinal necrosis on peripheral retina
  • Rapid progression of necrosis
  • Circumferential spread
  • Occlusive vasculopathy
  • Vitreal and aqueous inflammation

Differential Diagnosis

• Most commonly HSV and VZV, though CMV also possible

Clinical Manifestations

• Starts as anterior uveitis (painful, red eye with vision loss) that progresses to retinal necrosis
• High rates of retinal detachment and blindness

Management

• Directed by causative organism
• Involvement of Ophthalmology
• Typically requires intravenous ± intravitreal acyclovir, stepped down to oral valacyclovir after 5 to 10 days, to complete 3 months
  • Sometimes intravitreal ganciclovir or foscarnet is added
• May require steroids, usually added after 24 hours of antiviral therapy
• May require vitrectomy or laser therapy