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 28-year-old caucasian woman presented to the emergency room with a history of a pressure-type frontal headache during the previous week; there was no exacerbation when lying down nor with Valsalva maneuvers and no accompanying features, namely, visual symptoms. Medical history was unremarkable except for venous thrombosis on her left leg 5 years before. She was not taking any drugs other than oral contraceptives. She had a son who was diagnosed with chickenpox two weeks before. She was febrile (temperature of 38°C), and there was a rash suggestive of chickenpox. Uncorrected visual acuity was 20/20 in both eyes, and the optic discs were swollen and hyperemic, with ophthalmological and neurological examinations otherwise normal. Two days later, she complained of ocular pain on eye movement and bilateral blurred vision. By that time, examination revealed reduced visual acuity of 20/32 in her right eye (OD) and 20/60 in her left eye (OS) and relative afferent pupillary defect on her left eye. She reported a difference in brightness of the red color, with less saturation in the left eye.\nRoutine blood testing and immunological workup (ANA, ANCA, anticardiolipin antibodies, and complement levels) were normal. HIV serology was negative as well as VDRL, Toxoplasma, Bartonella, and Borrelia antibodies.\nCerebral computed tomography (CT) scan and magnetic resonance imaging (MRI) were normal.\nCerebrospinal fluid (CSF) examination was unremarkable: clear fluid with a normal opening pressure of 130–140 mm H2O with no block when pressing the jugular vein, normal protein and glucose levels, less than 5 leukocytes, and no oligoclonal bands. Antibodies for the following microorganisms were negative in the CSF: Cytomegalovirus, Epstein Barr virus, Parvovirus, Herpes simplex virus, Varicella zoster virus, Mycoplasma pneumoniae, Borrelia burgdorferi, and Leptospira species. VDRL was also negative in the CSF.\nGoldmann perimetry showed an enlarged blind spot and constriction of the nasal field, especially in her left eye (). Farnsworth Munsell 100 color vision test was abnormal in both eyes (in the red axis), with more pronounced defect in her left eye.\nShe was started on acyclovir 4 g/day per os, as is indicated to treat adult chickenpox.\nTwo days after the initial visual symptoms, visual acuity began to increase, and one week later, the optic disc edema had almost resolved (). Visual acuity continued to improve, and two months later, she had a visual acuity of 20/20 bilaterally. Retinal fluorescein angiography one month after presentation was normal. She has been free of further attacks of optic neuritis for three years after the admission.