Bilateral acute herpetic viral retinitis: A rare case report

• Author Details:   
• Solasa Deepthi ^*
• Adhitya Ram Ganesh
• Priethikka Mohanarangam Selvakumaar

---

View PDF

Herpetic viral retinitis, which includes acute retinal necrosis (ARN) and progressive outer retinal necrosis (PORN), is a rare but devastating vision-threatening condition caused primarily by herpes simplex virus (HSV) and varicella-zoster virus (VZV). It is characterized by necrotizing retinitis, often beginning in the peripheral retina and progressing centrally. Unlike uveitic or diabetic macular edema, macular edema and neurosensory detachment are uncommon due to the predominance of ischemic necrosis and vascular occlusion over exudation. A 20-year-old male presented with defective vision in both eyes for one week. His vision loss was gradual and associated with mild pain. Examination revealed hand movement (HM+) vision in the right eye and 6/36 vision in the left eye, improving to 6/24 with pinhole correction. Fundoscopic findings included retinal necrosis, splinter hemorrhages, and macular edema. Spectral domain OCT showed neurosensory detachment and cystic spaces. The TORCH profile was positive for herpes virus IgM and IgG. Treatment with intravenous acyclovir followed by oral acyclovir and steroids resulted in significant visual improvement (6/9 in the right eye, 6/6 in the left eye) after one month. Macular edema and neurosensory detachment are rare in herpetic viral retinitis because the primary pathological mechanism is retinal necrosis rather than inflammatory leakage or choroidal dysfunction. Most cases of vision loss are due to retinal ischemia, vascular occlusion, or rhegmatogenous retinal detachment rather than macular swelling or subretinal fluid accumulation.