Combined central retinal artery and vein occlusion with optic perineuritis following herpes zoster dermatitis in an immunocompetent child

Abstract

A 15-year-old healthy boy developed acute, rapidly progressing visual loss in left eye following herpes zoster dermatitis, with a combined central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO), along with optic perineuritis. Laboratory tests were negative. Despite an empirical, intensive antiviral treatment with systemic corticosteroids, and vision could not be restored in the affected eye. Herpes zoster dermatitis, in an immunocompetent individual, may be associated with a combined CRAO and CRVO along with optic perineuritis, leading to profound visual loss.

Figure 1

Skin lesions on left side of forehead and upper eyelid

Figure 2

(a) Ultra-widefield fundus photograph of left eye illustrating extensive retinal hemorrhages over the posterior pole and optic disc, with retinal edema, and frosted branch angiitis in the posterior pole (b) Fundus fluorescein angiography showing blocked fluorescence due to dense hemorrhages in posterior pole, extremely sluggish blood flow in the arteries in early phase (left), delayed venous filling, retinal vascular leak from frosted branch angiitis in the posterior pole in the late phase (right), suggesting a combined central retinal vein occlusion and central retinal artery occlusion (c) Optical coherence tomography showing massive retinal thickening, intraretinal and subretinal fluid precluding identification and differentiation of retinal layers (d) Magnetic resonance imaging orbit showing left optic perineuritis (arrows)