13.9 Viral Retinitis Associated Retinal Detachment

Viral retinitis is a rare disease which can occur in healthy and in immunocompromised individuals. It involves the ocular infection with Herpesviridae. Untreated viral retinitis can be complicated by retinal detachment.

Acute Retinal Necrosis (ARN)

This presents most commonly in immunocompetent patients where the causative viral agent is VZV or less frequently HSV. In the early acute herpetic phase, the inflammation may involve several layers of the eye (panuveitis). In the late cicatricial phase, changes at the vitreoretinal interface can lead to multiple retinal breaks within and at the edge of necrotic retina. Proliferative vitreoretinopathy and the formation of membranes cause traction which ultimately leads to retinal detachment in 50-75% of eyes with untreated ARN.

Progressive Outer Retinal Necrosis (PORN)

Progressive outer retinal necrosis generally affects immunocompromised patients. Typically, there is little intraocular inflammation combined with multiple foci of progressive outer retinal opacification sparing vasculature in the initial phase, however often involving the macula. VZV is also here the predominant causative agent followed by HSV. Retinal detachment can occur in 70% of patients with PORN within 4 weeks. They tend to progress quickly to total retinal detachment.

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