A Case of Acute Vision Loss Due to Delayed Onset Herpes Zoster Optic Perineuritis

Herpes zoster ophthalmicus can present with many ophthalmic complications, but optic nerve sheath involvement occurs in less than 1% of those affected. We describe a case of a patient who presented with delayed-onset optic perineuritis despite appropriate treatment with intravenous antivirals early in her disease course. This case helps to highlight the severe vision loss that can occur with optic perineuritis, the importance of neuroimaging and lumbar puncture in guiding diagnosis, and how visual recovery may be achieved with the addition of intravenous steroids to the treatment regimen.