Bilateral acute retinal necrosis caused by two separate viral etiologies

PURPOSE: To describe an unusual case of bilateral acute retinal necrosis (ARN) that was caused by varicella zoster virus in one eye and Epstein-Barr virus in the fellow eye. OBSERVATIONS: A 67-year-old immunocompromised man presented with ARN in the left eye following a dermatomal vesicular rash, with an aqueous sample positive for varicella zoster virus. Four months later, the patient presented with panuveitis and serous retinal detachment in the right eye, with vitreous sample positive for Epstein-Barr virus and negative for varicella zoster, herpes simplex, and cytomegalovirus. CONCLUSIONS AND IMPORTANCE: We report a rare case of bilateral ARN with independent infection of each eye by different viruses; varicella zoster in the left eye and, four months later, Epstein-Barr virus in the right eye. Immunocompromised patients are vulnerable to ARN from any of its inciting viral causes, and intraocular fluid should be obtained for diagnostic confirmation from the second eye in cases of bilateral ARN.