Molecular diagnosis and ocular imaging of varicella zoster virus associated neuroretinitis

PURPOSE: To report a case of varicella zoster virus associated neuroretinitis confirmed via polymerase chain reaction analysis of ocular fluid. OBSERVATIONS: A 30-year-old man presented with a 1-week history of decreased vision in his left eye and ulcerative skin lesions above his left eyebrow. On exam, he had clinical findings consistent with neuroretinitis characterized by optic disc edema and formation of a macular star. Polymerase chain reaction analysis of aqueous fluid was positive for varicella zoster virus. He was treated with oral valacyclovir with excellent resolution of his symptoms and clinical findings. CONCLUSIONS AND IMPORTANCE: Varicella zoster virus is a rare cause of neuroretinitis. We report for the first time a case of varicella zoster virus associated neuroretinitis confirmed by polymerase chain reaction analysis of ocular fluid. Molecular testing of ocular tissue may lead to a definitive diagnosis.