Acute Retinal Necrosis Workup

Updated: Feb 14, 2017
  • Author: Andrew A Dahl, MD, FACS; Chief Editor: C Stephen Foster, MD, FACS, FACR, FAAO, FARVO  more...
  • Print
Workup

Approach Considerations

Acute retinal necrosis (ARN) is a clinical diagnosis. [10, 11]

Next:

Laboratory Studies

Laboratory tests are nondiagnostic and may not be conclusive.

Viral titers for the following may be helpful:

  • Herpes simplex virus 1
  • Herpes simplex virus 2
  • Varicella-zoster virus

For baseline, obtain the following:

  • Complete blood cell count
  • Renal function tests
  • Liver function tests
Previous
Next:

Imaging Studies

Fluorescein angiography is as follows:

  • Not diagnostic
  • Early decrease in choroidal perfusion
  • May show delayed arterial filling
  • Hypofluorescence in areas of active lesions

Ocular ultrasound is as follows:

  • Can rule out retinal detachment in the presence of media opacity sufficient to obscure retinal examination
  • May show enlarged optic nerve sheath [12]

CT scan may show optic nerve sheath enlargement.

MRI may demonstrate concurrent lesions of the optic tract and the lateral geniculate body, suggesting axonal spread.

Previous
Next:

Procedures

Lumbar puncture may show cerebrospinal fluid pleocytosis.

Previous
Next:

Staging

Stage 1 is necrotizing retinitis, with the following substages:

  • Stage 1a - Discrete areas of peripheral retinitis
  • Stage 1b - Confluent areas of peripheral retinitis, papillitis, and macular edema

Stage 2 is vitreous opacification or organization.

Stage 3 is regression of retinal necrosis, with secondary pigmentation of the lesion with condensation of the vitreous base.

Stage 4 is retinal detachment, with the following substages:

  • Stage 4a - Acute tractional retinal tears or detachment with traction or proliferative vitreoretinopathy
  • Stage 4b - Chronic retinal detachment
Previous