Treatment of Herpes Zoster in Acute Retinal Necrosis as a Complication of Herpes Zoster Ophthalmicus
Acute retinal necrosis (ARN) is a rare but severe ocular complication of herpes zoster ophthalmicus. Because ARN is rapidly progressive and can threaten vision in both eyes, it requires prompt, structured systemic management.
Clinical Scenario
Herpes zoster presenting with acute retinal necrosis as a complication of herpes zoster ophthalmicus — a sight-threatening emergency in which immediate intervention is indicated.
Treatment Approach
Management is built around systemic antiviral induction therapy — intravenous treatment followed by an extended oral antiviral course. Supplementary anti-inflammatory treatment may be considered as an adjunct.
Full regimen, sequencing, and duration are specified in the complete protocol below.
Treatment Goal
Prevent spread of retinal necrosis to the contralateral eye.
References
DOI: 10.1111/ddg.14013
- In patients with acute retinal necrosis (as complication of herpes zoster ophthalmicus), systemic antiviral induction therapy with intravenous acyclovir (10 mg/kg three times daily for 7–10 days)* followed by oral acyclovir (800 mg five times daily) or oral valacyclovir (1,000 mg three times daily) for 3–4 months* is recommended.
- In patients with acute retinal necrosis (as complication of herpes zoster ophthalmicus), topical and systemic corticosteroids may be recommended for supplementary antiinflammatory treatment.
- Given that acute retinal necrosis is rapidly progressive and may spread to the contralateral eye, immediate intravenous induction therapy followed by oral antiviral therapy for 3–4 months is indicated (Table 21).
View source ↗