Acute Retinal Necrosis Treatment & Management

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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Approach Considerations

Retinal lesions regress a mean of 3.9 days after initiation of antiviral therapy. No new retinal lesions or progressive optic nerve involvement has been noted 48 hours or more after treatment is initiated. [13]

Timely clinical diagnosis hastens earlier antiviral therapy. Better initial visual acuity makes for better visual outcomes. [4]


Medical Care

Acute retinal necrosis (ARN) treatment consists of the following [14, 15, 16, 17] :

  • Antiviral therapy, including intravenous acyclovir, oral valacyclovir, oral famciclovir, intravitreal foscarnet, intravitreal valacyclovir, or intravitreal famciclovir, [18, 13, 19, 20] or a combination of oral and intravitreal antiviral therapies: Given the evidence that most cases of ARN are due to varicella-zoster or herpes simplex viral infection, acyclovir therapy is recommended. Most clinicians have observed that acyclovir speeds the regression of ARN and prevents new lesion formation. [18]  There is a significant correlation between prompt treatment and outcomes. [21]

  • Anti-inflammatory therapy

  • Antithrombotic therapy

  • Retinal detachment prophylaxis

For severe ARN, early vitrectomy with laser demarcation of areas of retinal necrosis together with intravenous antiviral agents should be considered. [22]


Surgical Care

Surgical procedures, such as the following, are required when retinal detachment occurs:

  • Vitrectomy

  • Endolaser

  • Possible scleral buckle

  • Intraocular tamponade: Silicone oil is the usual choice due to the multiple necrotic/atrophic retinal holes (Swiss cheese appearance).

  • C3 F8 (octafluoropropane/perfluoropropane) or other fluoridated gases for temporary absorbable intraocular tamponade



Consultations may be obtained from an infectious disease specialist or internist.