A 3-year-old immunocompetent boy with a 3-day history of typical chicken pox presented with blurred vision in the left eye, in a report from the University of Bern, Switzerland. The optic nerve was swollen and a puffy yellowish lesion covered the posterior pole and macula, consistent with retinitis and retinal edema. Active encephalitis was ruled out by lumbar puncture and negative CSF viral studies. Serology was positive for varicella (IgM), and negative for other virus infections. Treatment included a 10-day course of iv acyclovir and oral prednisone, followed by a 3 month course of oral acyclovir. The right eye was unaffected but a macular scar and optic nerve atrophy developed in the left eye, and visual acuity was 20/400 with no improvement after 9-year follow-up. [1]

COMMENT. The authors cite only 5 cases of chickenpox associated retinitis and 10 of optic neuritis previously reported. Prompt ophthalmological examination is recommended in a child with varicella who presents with reddening of an eye or blurred vision, to exclude papillitis or necrotizing retinitis. Prompt antiviral therapy may help to preserve some residual vision and prevent extension of the lesion. Systemic corticosteroids are not generally advocated, and possible benefits of a brief course used in the above child with a fulminant retinopathy would require confirmation by controlled trial.