Optic neuropathy preceding acute retinal necrosis in acquired immunodeficiency syndrome

Objective: To describe the clinical course of varicella-tester optic neuropathy preceding acute retinal necrosis in patients with acquired immunodeficiency syndrome. Design: Case series. Setting: Two tertiary care centers in San Diego, Calif, and London, England. Patients: Three human immunodeficiency virus-positive men with previous cutaneous tester infection, optic neuropathy, and necrotizing retinitis. Results: All patients had an episode of tester dermatitis treated with acyclovir. Visual loss consistent with an optic neuropathy ensued, followed by typical herpetic retinitis. The cause of visual loss was not suspected to be varicella-zoster until after the retinitis occurred. Despite aggressive medical treatment, 4 of 6 eyes progressed to retinal detachment. Conclusions: Varicella-zoster may cause an optic neuropathy in patients with acquired immunodeficiency syndrome, especially in those with previous shingles. A high index of suspicion is necessary to establish the diagnosis and begin early antizoster treatment.