Acute Retinal Necrosis Clinical Presentation

Updated: Feb 16, 2021
  • Author: Andrew A Dahl, MD, FACS; Chief Editor: C Stephen Foster, MD, FACS, FACR, FAAO, FARVO  more...
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Typically, acute retinal necrosis is a disease of immunocompetent individuals. Initially, patients may complain of the following:

  • Red eye

  • Periorbital pain

  • Hazy vision or decreased vision

  • Appearance of floaters

  • Decreased color vision

  • Other areas of previous infections - Primary varicella infections, herpes zoster

Infection with herpes simplex virus (HSV-1 or HSV-2) and VZV can cause widely variable clinical manifestations, ranging from the typical severe acute retinal necrosis to more atypical, slowly progressing necrotizing and nonnecrotizing inflammation. [5]

In the era prior to the advent of antiviral therapy, bilateral involvement occurred in one third to three quarters of cases. The commencement of second eye infection ranged from 24 hours to 6 months months after the first eye’s involvement. [6]



Examination findings may include the following:

  • Anterior uveitis (iritis)

  • Panuveitis

  • Keratic precipitates - Fine or granulomatous

  • Occlusive retinal vasculitis involving arteries and veins

  • One or more focus of retinitis, resulting in necrosis with discrete borders located in the retinal periphery with circumferential spread

  • Vitritis (shown in the image below)

  • Optic neuropathy

    Severe vitritis with occlusive arteriolitis. Severe vitritis with occlusive arteriolitis.


Most cases of acute retinal necrosis have been reported to be caused by the following [7] :

  • Varicella-zoster virus

  • Herpes simplex type 1

  • Herpes simplex type 2 [8]


Physical Examination

Careful and complete ophthalmological examination should be undertaken in all patients with anterior uveitis. Fundoscopy following pupillary dilation should include examination of the peripheral retina to search for areas of retinal whitening or vasculitis.



Retinal detachment is the principal complication of ARN. Prompt diagnosis and early treatment decreases the risk of retinal detachment and improves visual acuity outcomes. [9]