Early Presentation of Successive Acute Retinal Necrosis Decades After Initial Infection

<b>Purpose:</b> To describe the early presentation of successive acute retinal necrosis (ARN) decades after the initial infection. <b>Methods:</b> A single case and its findings were analyzed. <b>Results:</b> A 62-year-old man with a remote history of left-sided ARN presented for evaluation of right-sided blurry vision. An examination showed 1+ anterior chamber cells and mild vitritis with multiple small patches of white retinitis. The lesions progressed despite treatment with oral antivirals, eventually requiring multiple doses of intravitreal antiviral agents and hospitalization for intravenous antiviral therapy. Despite a characteristic clinical picture consistent with ARN, multiple aqueous samples tested negative for viral etiologic agents. <b>Conclusions:</b> ARN is a rapidly progressive disease, and the diagnosis is clinical. Our patient was treated aggressively with antiviral therapy on the basis of the clinical picture without confirmatory testing, which remained negative. The lesions responded well to treatment and 20/25 visual acuity was maintained. Regardless of confirmatory testing, timely treatment is critical in cases of suspected ARN.