Presentation: blurred vision, floating spots, pain, and or external ocular injection
Criteria for diagnosis:
(1) necrotizing retinitis with peripheral to midperipheral pale yellow retinal exudates
(2) vitreous opacity (associated with inflammatory cells and necrotic debris)
(3) anterior uveitis
(4) evidence for herpes simplex or herpes zoster (by viral culture, serology, PCR, recent history of shingles in the ophthalmic branch of the fifth cranial nerve, primary chickenpox)
where:
• Cytomegalovirus (CMV) may cause a similar syndrome.
• PORN (progressive outer retinal necrosis) refers to a fulminant herpes virus infection that occurs in AIDS patients (see pages 10.11.4-10.11.5 in Hudson et al).
The course may vary depending on whether:
(1) the patient is immunocompetent vs immunocompromised
(2) treatment has been promptly started
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Retinal Lesions
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Other
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Outcome
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Severity
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non-confluent; stationary/localized, or extends gradually towards the posterior pole
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localized retinochoroidal degeneration; little or no vasculitis
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usually return to previous visual acuity
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mild
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become confluent and rapidly extend to involve the posterior pole; widespread
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retinal detachment, severe retinal arteritis
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may progress to blindness
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severe or fulminant
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Treatment consists of both acyclovir and corticosteroids. If retinal detachment occurs, then surgical or laser reattachment may be attempted.
If only 1 eye is involved, long term treatment with oral acyclovir may be needed to prevent involvement of the second eye or recurrence in the same eye.
