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 woman with rheumatoid arthritis, sleep apnea and a body mass index of 55 presented with nausea, vomiting and floaters in the right eye for two days. Two weeks prior, she developed positional headaches, blurry vision and transient visual obscurations. On presentation, her best corrected visual acuity was 20/25 in each eye, there was no relative afferent pupillary defect and the examination of external structures and anterior segment was unremarkable.\nFunduscopic examination revealed Frisen grade 4 papilledema in the right eye with vitreous, subretinal and intraretinal hemorrhages, and grade 3 in the left eye with flame-shaped hemorrhages (A, ).\nHead CT with contrast appeared normal, an MRI was not possible due to body habitus and weight restrictions. Lumbar puncture under fluoroscopic guidance revealed opening pressure of 310 mm CSF with normal composition. Humphrey visual field 24-2 SITA Fast was reliable with an enlarged blind spot and a few central changes in the right eye (mean deviation −4.00 dB) and was essentially full with mild central depression in the left eye (mean deviation −3.55 dB).\nShe was started on acetazolamide 500 mg twice daily, which was titrated up to 1500 mg twice daily with gradual resolution of symptoms over a month. At two month follow up, the vitreous hemorrhage had resolved and there was marked improvement in the papilledema bilaterally ( C, D).