Varicella zoster retinal vasculitis without retinitis: a literature review

ABSTRACT Introduction Varicella zoster virus (VZV) uveitis presenting as acute retinal necrosis with vasculitis is well known, but VZV-vasculitis without retinitis is rarely reported. Identification of such presentation can be challenging, especially when other signs of ocular VZV are absent. This is particularly important before considering immunomodulatory therapy for retinal vasculitis without systemic manifestations. Areas covered An online English language literature search for ‘VZV retinal vasculitis presenting without retinitis’ was made and case reports and case series published from 1995 to 2020 were reviewed. The search revealed 26 cases from 21 reports in 25 years. The clinical manifestation, morphology of vasculitis, visual and treatment outcomes were studied. Expert opinion Recent or old history of Herpes Zoster Ophthalmicus or chickenpox especially in young individuals should be elicited in isolated retinal vasculitis. Diagnostic relevance of PCR and serological tests should be investigated further in larger studies. Occlusive nature of vasculitis, including arteriolitis, is common in VZV infection. In chronic cases, end point of antiviral therapy remains unknown. Patients should be warned of grave visual prognosis despite adequate treatment. The importance of adjuvant anti-thrombotic therapy along with anti-viral and immunomodulatory therapy needs to be explored further.