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 39-year-old man, complained about a 3-day history of bilateral blurred vision. He had a past medical history of kidney transplantation 5 years ago and was receiving systemic immunosuppressive therapy. The patient was hospitalized for chickenpox and was treated with systemic antivirals 3 weeks prior to ocular symptoms onset. On ophthalmic examination, the patient’s best corrected visual acuity (BCVA) was 20/200 in the right eye (RE) and 20/25 in the left eye (LE). Slit-lamp examination showed stromal keratitis and few fine keratic precipitates in the RE (Fig. ) and 1+ anterior chamber cells in both eyes. Intraocular pressure was 22 mmHg in the RE and 20 mmHg in the LE. There were no vitreous cells, and results of dilated fundus examination were unremarkable in both eyes. The patient was diagnosed with keratouveitis in the RE and acute anterior uveitis in the LE secondary to chickenpox. He was treated with topical acyclovir five times a day, dexamethasone six times a day, beta blockers, and atropine 1% twice daily. He was lost to follow-up. One year later, he presented with a 1-week history of blurry vision bilaterally. On ophthalmic examination, BCVA was 20/200 in the RE and 20/30 in the LE. Slit-lamp examination showed “mutton-fat” pigmented keratic precipitates (Fig. ), 1+ anterior chamber cells, corneal scars, patchy iris atrophy with circumscribed depigmented spots of the iris, and distorted pupil (Fig. ) in both eyes. Intraocular pressure was 27 mmHg in the RE and 24 mmHg in the LE. Assessment of posterior segments revealed no abnormalities in both eyes. A diagnosis of recurrent granulomatous anterior uveitis was made. The patient was treated with topical dexamethasone six times a day, topical acyclovir five times a day, beta blockers, and atropine 1% twice daily. Intraocular inflammation gradually resolved, and visual acuity improved. Topical steroids and acyclovir were slowly tapered. Visual acuity improved to 20/25 in both eyes one month after presentation. No recurrence of intraocular inflammation was observed over a follow-up period of 24 months.