International Ophthalmology

, Volume 38, Issue 2, pp 829–832 | Cite as

Herpes zoster keratitis development after acute retinal necrosis

  • Waseem H. Ansari
  • Francesco Pichi
  • Paula E. Pecen
  • Careen Y. Lowder
  • Sunil K. Srivistava
Case Report



To report a case of herpes zoster keratitis in a patient undergoing treatment for herpetic acute retinal necrosis.


Case report.


A 71 year old male presented with acute retinal necrosis of the left eye due to herpes zoster and was treated with intravitreal foscarnet and oral valcyclovir. He developed a retinal detachment and underwent surgical repair. After four weeks, he developed an ipsilateral herpetic zoster keratitis demonstrated by Rose-Bengal staining that was responsive to topical ganciclovir gel.


This case report describes the unusual development of herpes zoster keratitis after the development of unilateral acute retinal necrosis (ARN) in a patient on antiviral treatment.


Acute retinal necrosis Herpes zoster keratitis Acyclovir resistance 


Compliance with ethical standards

Conflict of interest

Waseem Ansari declares that he has no conflict of interest. Francesco Pichi declares that he has no conflict of interest. Paula E. Pecen MD declares that she has no conflict of interest. Careen Y. Lowder MD declares that she has no conflict of interest. Sunil K. Srivistava declares that she has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this case review, formal consent is not required.


  1. 1.
    Ludwig IH, Zegarra H, Zakov ZN (1984) The acute retinal necrosis syndrome. Possible herpes simplex retinitis. Ophthalmology 91(12):1659–1664CrossRefPubMedGoogle Scholar
  2. 2.
    Chambers RB, Derick RJ, Davidorf F, Koletar SL, Dangel ME (1989) Varicella-zoster retinitis in human immunodeficiency virus infection. Arch Ophthalmol 107:960–961CrossRefPubMedGoogle Scholar
  3. 3.
    Nakanishi F, Takahashi H, Ohara K (2000) Acute retinal necrosis following contralateral herpes zoster ophthalmicus. Jpn J Ophthalmol 44(5):561–564CrossRefPubMedGoogle Scholar
  4. 4.
    Sado K, Kimura T, Hotta Y et al (1994) Acute retinal necrosis syndrome associated with herpes simplex keratitis. Retina 14(3):260–263CrossRefPubMedGoogle Scholar
  5. 5.
    Smith LK, Kurz PA, Wilson DJ, Flaxel CJ, Rosenbaum JT (2007) Two patients with the von Szily reaction: herpetic keratitis and contralateral retinal necrosis. Am J Ophthalmol 143(3):536–538CrossRefPubMedGoogle Scholar
  6. 6.
    Gueudry J, Boutolleau D, Gueudin M et al (2013) Acyclovir-resistant varicella-zoster virus keratitis in an immunocompetent patient. J Clin Virol 58(1):318–320CrossRefPubMedGoogle Scholar
  7. 7.
    Lee MY, Kim KS, Lee WK (2011) Intravitreal foscarnet for the treatment of acyclovir-resistant acute retinal necrosis caused by varicella zoster virus. Ocul Immunol Inflamm 19(3):212–213CrossRefPubMedGoogle Scholar
  8. 8.
    Jeon S, Kakizaki H, Lee WK, Jee D (2012) Effect of prolonged oral acyclovir treatment in acute retinal necrosis. Ocul Immunol Inflamm 20(4):288–292CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2017

Authors and Affiliations

  • Waseem H. Ansari
    • 1
  • Francesco Pichi
    • 1
  • Paula E. Pecen
    • 2
  • Careen Y. Lowder
    • 1
  • Sunil K. Srivistava
    • 1
  1. 1.Cleveland Clinic FoundationCole Eye InstituteClevelandUSA
  2. 2.Department of OphthalmologyUniversity of Colorado School of MedicineAuroraUSA

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