Herpes virus family including herpes simplex virus (HSV), varicella-zoster virus (VZV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), and pseudorabies virus (PRV). Herpes virus infections may accompany with dermatological, ophthalmological, neurological complications. Viral acute retinal necrosis (ARN) present with rapidly progressive necrotizing retinitis and vasculitis. And optic neuritis (ON) is a rare complication of the eye associated with viral encephalitis. Lack of awareness of herpes related visual impairment often leads to postponed diagnosis and treatment.

A total of 13 patients with a median age at onset of 50.5 years (range 31-66) were included in the study. The types of herpes virus infections included VZV, HSV, EBV, and PRV, with VZV being the most common positive in 10 patients (76.9%). Diagnoses related to vision loss included optic neuritis (ON; 7, 53.8%), peripapillary ON (1, 7.7%), and acute retinal necrosis (ARN; 5, 38.5%). All 10 cases of VZV infection had signal abnormalities involving either optic nerve or optic nerve sheath, including one with combined meningeal involvement and another with brain parenchyma. The remaining three cases of HSV, EBV, and PRV infections combined with viral encephalitis had parenchymal involvement. All patients received both steroids and antiviral treatments. The duration to start intravenous (i.v) antiviral therapy ranged from 5 to 39 days, with a median time of 16 days.

The clinical presentation of visual impairment after herpes virus infection is heterogeneous. With a lack of clinical awareness and delays in diagnosis and treatment, prognoses of these entities are disastrous.