Bilateral Retrobulbar Neuritis following Unilateral Herpes Zoster Ophthalmicus

Abstract

A 48-year-old male diagnosed with right-onset herpes zoster ophthalmicus developed visual acuity loss in the left eye during the following 3 weeks. Visually evoked cortical potential recordings revealed a marked increase in P100 latency and a marked decrease in its amplitude in both eyes. Pattern electroretinography suggested diffuse pathology with reduced positive and negative components. A possible transsynaptic or intraneural spread of the varicella-zoster virus in the optic nerve might be responsible for this unexplained contralateral loss of visual acuity.

A Case of Optic Neuritis Complicating Herpes Zoster Ophthalmicus in a Child

“…In comparison, optic nerve involvement of HZO in adults has been frequently reported. This condition may present as papillitis, optic neuritis, or optic nerve infarction [19]. Optic neuritis following HZO appears weeks to months after the onset of skin lesions, and loss of visual acuity varies from severe bilateral impairment to moderate unilateral impairment [20].…”

“…(1) Direct extension of the virus through the cavernous sinus to nerves, muscles, and the optic nerve [19]. …”

“…(2) Local extension into the meninges and brain tissue may lead to mild meningoencephalitis, which, in turn, may damage the optic nerve [19,21]. …”

“…Unfortunately, a visual field test could not be obtained secondary to the patient's age and inability to cooperate with the exam. Visual outcomes are usually poor in the setting of optic neuropathy resulting from HZO [19] when steroids are used as monotherapy (Table 1). Following the administration of antiviral agents, such as acyclovir, visual acuity generally improves.…”

Bilateral Retrobulbar Optic Neuritis Caused by Varicella Zoster Virus in a Patient with AIDS

“…The ocular manifestations of VZV infection include dermatitis, keratitis, uveitis, retinitis and optic neuritis. Infectious retrobulbar optic neuritis caused by VZV is rare but well documented, it can present with or without concurrent VZV cutaneous lesions and can lead to vision loss [ 1 , 2 ], it has been reported in HIV negative [ 3 - 5 ] and HIV positive patients [ 6 - 14 ]. We describe a case of a patient with AIDS and bilateral retrobulbar optic neuritis, the visual symptoms preceded the appearance of trigeminal herpes zoster and the fundoscopic exam was normal.…”