OPTIC NEUROPATHY PRECEDING ACUTE RETINAL NECROSIS IN ACQUIRED-IMMUNODEFICIENCY-SYNDROME

Objective: To describe the clinical course of varicella-tester optic n europathy preceding acute retinal necrosis in patients with acquired i mmunodeficiency syndrome. Design: Case series. Setting: Two tertiary c are centers in San Diego, Calif, and London, England. Patients: Three human immunodeficiency virus-positive men with previous cutaneous test er infection, optic neuropathy, and necrotizing retinitis. Results: Al l patients had an episode of tester dermatitis treated with acyclovir. Visual loss consistent with an optic neuropathy ensued, followed by t ypical herpetic retinitis. The cause of visual loss was not suspected to be varicella-zoster until after the retinitis occurred. Despite agg ressive medical treatment, 4 of 6 eyes progressed to retinal detachmen t. Conclusions: Varicella-zoster may cause an optic neuropathy in pati ents with acquired immunodeficiency syndrome, especially in those with previous shingles. A high index of suspicion is necessary to establis h the diagnosis and begin early antizoster treatment.