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Steven M. Friedlander, MD; Firas M. Rahhal, MD; Lamont Ericson, MD; J. Fernando Arrevalo, MD; Judith D. Hughes, FRCOphth; Leah Levi, MD; Clayton A. Wiley, MD, PhD; Elizabeth M. Graham, FRCP, DO, FRCOphth; William R. Freeman, MD

Arch Ophthalmol. 1996;114(12):1481-1485.

Abstract
Objective
To describe the clinical course of varicellazoster optic neuropathy preceding acute retinal necrosis in patients with acquired immunodeficiency syndrome.

Design
Case series.

Setting
Two tertiary care centers in San Diego, Calif, and London, England.

Patients
Three human immunodeficiency virus-positive men with previous cutaneous zoster infection, optic neuropathy, and necrotizing retinitis.

Results
All patients had an episode of zoster dermatitis treated with acyclovir. Visual loss consistent with an optic neuropathy ensued, followed by typical herpetic retinitis. The cause of visual loss was not suspected to be varicella-zoster until after the retinitis occurred. Despite aggressive medical treatment, 4 of 6 eyes progressed to retinal detachment.

Conclusions
Varicella-zoster may cause an optic neuropathy in patients with acquired immunodeficiency syndrome, especially in those with previous shingles. A high index of suspicion is necessary to establish the diagnosis and begin early antizoster treatment.

Author Affiliations
From the Departments of Pathology, University of California, San Diego, La Jolla, (Drs Friedlander, Rahhal, Ericson, Arrevalo, Levi, and Freeman), St Thomas' Hospital, London, England (Drs Hughes and Graham), and University of Pittsburgh, Pittsburgh, Pa (Dr Wiley). Dr Friedlander is now with the Department of Ophthalmology, University of Illinois, Illinois Eye and Ear Infirmary, Chicago.

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