Herpes zoster keratitis development after acute retinal necrosis

Area of Science:

• Ophthalmology
• Virology
• Infectious Diseases

Background:

• Herpes zoster ophthalmicus can manifest with ocular complications.
• Acute retinal necrosis (ARN) is a severe intraocular inflammation often caused by varicella-zoster virus.
• Ocular herpes zoster infections require prompt diagnosis and management.

Observation:

• A 71-year-old male with herpes zoster-induced acute retinal necrosis (ARN) of the left eye was treated with intravitreal foscarnet and oral valacyclovir.
• The patient subsequently developed a retinal detachment requiring surgical intervention.
• Four weeks post-treatment initiation, he presented with ipsilateral herpes zoster keratitis, diagnosed via Rose-Bengal staining.

Findings:

• The herpes zoster keratitis was successfully treated with topical ganciclovir gel.
• This case highlights an unusual progression of ocular herpes zoster infection.
• The development of keratitis occurred despite ongoing systemic and local antiviral therapy for ARN.

Implications:

• This case underscores the importance of vigilant monitoring for secondary ocular complications in patients with severe herpes zoster infections.
• It suggests that herpes zoster keratitis can arise even during antiviral treatment for ARN.
• Further research may be warranted to understand the mechanisms and optimal management strategies for such unusual presentations.