Saving Vision in a Child With Light Perception Vision Due to Acute Retinal Necrosis Secondary to Herpes Simplex Virus Encephalitis.

Abstract

Herpes simplex virus (HSV) can affect both the central nervous system and the eye, most notably as herpes simplex encephalitis and the less common but vision-threatening acute retinal necrosis (ARN). The authors report a 13-year-old boy who developed ARN shortly after confirmed herpes simplex encephalitis despite appropriate systemic antiviral therapy. He presented with light perception vision, vitritis, retinal necrosis, and retinal detachment in the left eye, with HSV-1 detected by polymerase chain reaction from vitreous fluid. Intravitreal antiviral therapy was promptly administered, followed by early pars plana vitrectomy with silicone oil tamponade and 360-degree peripheral retinal laser, resulting in retinal reattachment and improvement of visual acuity to 20/200. After subsequent cataract extraction and silicone oil removal, visual acuity further improved to 20/80. This case emphasizes the importance of close ophthalmic monitoring in patients recovering from herpes simplex encephalitis, because ocular disease may develop rapidly even under systemic antivirals. It also underscores that early combined medical and surgical intervention can preserve meaningful vision in pediatric ARN complicated by retinal detachment. Such reports contribute to the limited literature linking herpes simplex encephalitis and ARN in children and highlight the potential for favorable outcomes with timely management.