Acute Retinal Necrosis Masked by Clinical Features of Orbital Inflammation

ABSTRACT

Purpose@#To describe a case of acute retinal necrosis with clinical features of orbital inflammation.Case summary: A 33-year-old female presented with right eye injection, chemosis, and pain. At the first visit, the uncorrectedvisual acuity and intraocular pressure of her right eye were 20/20 and 20 mmHg, respectively. Slit-lamp examination showed inflammatorycell 2+ in the anterior chamber of the right eye; an evaluation of the peripheral retina was not conducted. The nextday, computed tomography (CT) was performed due to aggravation of the orbital inflammation. High-dose intravenous methylprednisoloneinjection was initiated on the finding of posterior scleritis with orbital inflammation on CT scans; peripheral retinalnecrosis and obstructive vasculitis were also noted. Clinically determined to be acute retinal necrosis, the patient began systemicantiviral therapy. A diagnostic anterior chamber paracentesis was positive for herpes simplex virus type 2 by polymerasechain reaction. The patient was treated with intravenous acyclovir and intravitreal injections of foscarnet, as well as barrier lasertherapy. After two weeks of treatment, the patient was discharged with oral valacyclovir. During the three months of follow-up,the visual acuity of the right eye was hand motion, due to chronic optic disc swelling with chronic macular edema and maculardegeneration. Neither eye showed retinal lesion progression. @*Conclusions@#Rarely, acute retinal necrosis is accompanied by clinical manifestations of orbital inflammation. Therefore, if patientshave uveitis with orbital inflammation, it is important to consider the possibility of acute retinal necrosis and to examine theperipheral retina carefully.