A 35-year-old otherwise healthy man presented with a 1-week history of blurred vision in his RE. Medical history revealed mild chickenpox 3 weeks prior to his presentation, which resolved without complications. On ophthalmic examination, BCVA was 20/40 in the RE and 20/20 in the LE. There was no afferent pupillary defect. The intraocular pressure was 16 mmHg in both eyes. Minimal conjunctival hyperemia was present, and there were a few anterior chamber cells and 3+ vitreous cells and haze in the RE. Funduscopy revealed whitish retinal infiltration affecting the far periphery of the retina in one quadrant. Clinical examination results of the LE were normal.\nA diagnosis of ARN syndrome secondary to chickenpox infection was made, and the patient was treated with intravenous acyclovir (10 mg/kg, three times a day). Seven days later, there was no improvement in the RE, and the patient was given intravitreal ganciclovir (2 mg). After a 10-day course of intravenous acyclovir, the patient received valacyclovir (1000 mg, three times daily). Seven days after initiation of oral antiviral therapy, he received oral prednisone (0.5 mg/kg/day for 1 week, followed by gradual tapering over 8 weeks). Systemic corticosteroids were prescribed because of significant vitritis. BCVA of the RE improved to 20/20, with gradual resolution of vitreous inflammatory reaction. The peripheral retinal lesion healed with a residual chorioretinal scar. No fellow eye involvement or recurrence of ARN was observed after an 18-month period of follow-up.
A 42-year-old obese woman presented to her optometrist after she noticed “after images” following bright light exposure in her left eye (OS). She also noticed transient blurred vision with position changes but denied any regular headaches or pulsatile tinnitus. She denied ever having a severe onset headache. She was referred to neuro-ophthalmology and was found to have a visual acuity of 20/20 in both eyes. Humphrey 24-2 SITA-Fast visual fields showed nonspecific depressed points right eye (OD; MD −6.18 dB) and showed an enlarged blind spot OS (MD −4.84 dB). Dilated fundus examination showed moderate optic disc edema in both eyes with preretinal, intraretinal, and subretinal hemorrhages around the left optic disc (shown in Fig. ). Her blood pressure measured 140/100 and her hemoglobin was normal. Magnetic resonance imaging/magnetic resonance venography was performed and showed signs of raised ICP without a secondary cause. Lumbar puncture showed an opening pressure of 32 cm of water and normal cerebrospinal fluid (CSF) contents. She was started on acetazolamide 500 mg twice-daily (BID) and telmisartan 40 mg daily and the optic disc edema improved and resolved after 4 months with significant weight loss. She maintained normal visual function and the ODH resolved at 3 months. The final Humphrey mean deviation was −3.42 dB OD and −2.98 dB OS.