Acute retinal necrosis presenting exudative retinal detachment: a case report

Acute retinal necrosis (ARN) is a severe rapidly progressive viral retinitis typically complicated by retinal detachment in its late stage. This case report describes a rare presentation of ARN caused by varicella zoster virus (VZV) in a 43-year-old woman who presented with exudative retinal detachment in the early phase without clear evidence of retinal necrosis. The patient presented with blurred vision, eye redness, and ocular pain in the left eye lasting 3 days. Initial treatment with corticosteroids was started, but characteristic peripheral retinal necrotic lesions appeared two days later, leading to confirmation of VZV infection through metagenomic testing. Aggressive treatment with systemic intravenous acyclovir, intravitreal ganciclovir injections, and corticosteroids resulted in rapid resolution of the retinal detachment and complete healing of the lesions. Visual acuity remained stable at one-month follow-up.