Acute Retinal Necrosis (ARN)

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  • Usually caused by Varicella zoster virus (VZV) or Herpes simplex virus (HSV)
  • Often immunocompetent patients (in contrast to Progressive Outer Retinal Necrosis (PORN) in immunosuppressed patients)


  • Retinal periphery with small, multifocal, yellow-white infiltrates, might have haemorrhages
  • Rapid progression with circular spread without antiviral therapy
  • Occlusive vasculopathy, arterioles affected
  • Pronounced vitritis and/or anterior chamber cells


  • Clinical diagnosis!
  • Anterior chamber paracentesis


  • Screening (dilated fundoscopy) in patients with Herpes Zoster Ophthalmicus: ocular involvement?
    • may occur only after several weeks
  • Frequent retinal examinations due to high risk of retinal detachment


  • Systemic antiviral therapy with Aciclovir i.v. (10 mg/kg 3x/d for 7-14 days) followed by oral valaciclovir (1000 mg 3x/d) for 3-4 months.
    • CAVE: Dose adjustment in renal insufficiency, monitoring of renal values.
  • Systemic steroids from day 2: initial dose prednisone 1-2mg/kg
  • Consider intravitreal ganciclovir (or foscarnet).
  • Consider topical steroids + cycloplegics
  • Consider prophylactic laser therapy to prevent rhegmatogenous retinal detachment