A 34-year-old male patient diagnosed with chickenpox three weeks previously, which had resolved without complications. He came to the emergency department with a decrease in visual acuity in his left eye.
Ophthalmological examination showed a corrected visual acuity of 1 in the right eye (OD) and 0.6 in the left eye (OI). The slit-lamp study showed a cellular tyndall of 4+ in the OI, keratic precipitates (3+) and no fluorescein staining of the cornea, the OD being normal. Intraocular pressure was 16mmHg in both eyes.
Initial fundoscopic examination of the OI revealed mild vitritis (1+) with no foci of retinitis.
Topical treatment with corticosteroids and mydriatics was started. Two days later, a slight decrease in cellular tyndall (3+) was observed in the anterior chamber, but fundus examination revealed a peripheral focus of necrotising retinitis in the temporal area associated with retinal vasculitis.
The patient was admitted and treatment was started with intravenous acyclovir (10 mgr/kg/8 hours), antiplatelet therapy (acetylsalicylic acid 150 mgr/24 hours) and topical treatment was maintained. Prophylactic argon laser photocoagulation was also performed around the area of retinal necrosis.

After 48 hours and after verifying a good response with a decrease in the retinal focus, systemic corticosteroids were introduced at a dose of 1 mg/kg/d, showing a rapid improvement in visual acuity, with a decrease in vitritis and a smaller retinal focus. After 2 weeks, antiviral treatment (famciclovir 500 mgr/12 hours) was switched to oral therapy and a gradual decrease in corticosteroids was started at a rate of 10 mgr each week. Antiviral treatment was continued at maintenance doses for 6 weeks, with regular blood and biochemistry tests to detect renal involvement.
Six months after the onset of the disease, the patient remained asymptomatic, with a visual acuity of unity in the left eye, healing of the retinal lesions and complete absence of ocular inflammatory activity in both eyes.
During admission, recent varicella zoster virus infection was confirmed by seroconversion.