Varicella zoster virus retrobulbar optic neuritis preceding retinitis in patients with acquired immune deficiency syndrome.
OBJECTIVE
This study aimed to describe a recently recognized and rare presentation of varicella zoster virus (VZV) retrobulbar optic neuritis preceding retinitis in patients with acquired immune deficiency syndrome and to identify factors that may relate to improved visual outcome.


METHODS
Diagnosis, treatment, and clinical course are described for three eyes of two patients with this viral infection.


RESULTS
Patients had decreased vision, headache, and recent zoster dermatitis. Varicella zoster virus retrobulbar optic neuritis was diagnosed on the bases of clinical, laboratory, and electrophysiologic examination results. Profound vision loss and peripheral retinitis ensued despite intravenous antiviral treatment. Combination intravenous and intravitreous antiviral injections were administered with dramatic visual recovery.


CONCLUSIONS
Varicella zoster virus retrobulbar optic neuritis should be considered in immunocompromised patients with visual loss. Early diagnosis and aggressive combination therapy via systemic and intravitreous routes may enable return of useful vision.
Lee
M S
MS
Department of Ophthalmology, Yale University School of Medicine, New Haven, Connecticut, USA.
Cooney
E L
EL
Stoessel
K M
KM
Gariano
R F
RF
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D000212:Acyclovir / Q000627:therapeutic use; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D002555:Cerebrospinal Fluid / Q000821:virology; D005260:Female; D017245:Foscarnet / Q000627:therapeutic use; D005654:Fundus Oculi; D006563:Herpes Zoster Ophthalmicus / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D014645:Herpesvirus 3, Human / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008587:Meningitis, Viral / Q000209:etiology; D009902:Optic Neuritis / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D009916:Orbital Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D012173:Retinitis / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D017193:Skin Diseases, Viral / Q000209:etiology; D014792:Visual Acuity
D000998:Antiviral Agents; D017245:Foscarnet; D000212:Acyclovir