Varicella zoster virus acute retinal necrosis miming papillitis: a case report

BACKGROUND: Viral acute retinal necrosis is a rare acute uveitis characterized by peripheral necrotizing retinitis with severe functional damages. We reported an unusual case of varicella zoster virus acute retinal necrosis starting with optic nerve involvement. CASE PRESENTATION: A 55-year-old immunocompetent Caucasian woman presented with pain in the left eye and signs of papillitis with enlargement of the blind spot. Visual function rapidly decreased because of ocular inflammation within a few days. After ophthalmological and systemic tests, a diagnosis of varicella zoster virus acute retinal necrosis was made. A prompt treatment with intravenous acyclovir and early vitrectomy was performed. CONCLUSION: Optic disc involvement preceding retinal necrosis in varicella zoster virus acute retinal necrosis is a diagnostic challenge. A prompt diagnosis and treatment are pivotal to manage these patients, avoiding severe visual damage.