Herpetic panophthalmitis in a patient with a history of neonatal herpetic encephalitis

Herpetic acute retinal necrosis (ARN) with orbital inflammation is a rare form of panophthalmitis. We report the case of a 15-year-old boy with hypoxic ischemic encephalopathy (HIE) secondary to neonatal herpetic encephalitis who developed unilateral ocular inflammation and proptosis. Imaging and aqueous PCR confirmed orbital inflammation and active HSV infection. Given the patient's comorbidities, aggressive surgical treatment was not pursued. Treatment aimed at protecting the contralateral eye from involvement requires life-long antiviral prophylaxis.