Acute Retinal Necrosis: Presenting Characteristics and Clinical Outcomes in a Cohort of Polymerase Chain Reaction–Positive Patients

Viral retinitis: diagnosis and management in the era of biologic immunosuppression: A review

“…VZV is the commonest overall cause of ARN, followed by HSV . There is a bimodal age distribution, with peaks in the fourth and sixth decade . ARN in younger adults is typically caused by HSV‐2, while older adults tend to have VZV and HSV‐1‐related ARN .…”

“…This included chickenpox, shingles and herpes zoster ophthalmicus, central nervous system infection, and keratitis rarely. A history of viral encephalitis or meningitis strongly predicts HSV‐associated ARN . The incidence of ARN within 12 months of HSV encephalitis was 4‐8%, prompting recommendations for increased patient awareness …”

“…Regional corticosteroids are a known but rare risk factor . ARN can occur after intravitreal or periocular injections, and rarely after systemic or epidural administration . Overall, local steroid injections precipitate CMV retinitis three times more frequently than HSV or VZV retinitis .…”

“…Keratic precipitates may be granulomatous or non‐granulomatous. Over 85% of cases are unilateral at presentation . There is gradual coalescence of the retinal infiltrates with full‐thickness necrosis and circumferential progression, often with a scalloped edge and the posterior pole spared until late (Figure B).…”

“…There is gradual coalescence of the retinal infiltrates with full‐thickness necrosis and circumferential progression, often with a scalloped edge and the posterior pole spared until late (Figure B). Optic nerve involvement occurs in approximately 20% to 40%, notably with severe disease . The classical clinical presentation of peripheral retinal disease is primarily seen in immunocompetent patients, and can present as dense vitritis and a “headlight in the fog” appearance usually associated with ocular toxoplasmosis.…”