A 40-year-old immunocompetent man presents with 4 days of pain, redness, and rapidly progressive visual loss in the left eye. Fundus shows confluent peripheral necrotising retinitis with occlusive vasculitis and prominent vitritis, sparing the macula initially. The most appropriate first-line therapy is:

• A High-dose oral corticosteroids alone
• B Oral ganciclovir alone
• C Intravitreal methotrexate
• D Intravenous acyclovir followed by oral valacyclovir ✓

Explanation

This is acute retinal necrosis, caused by herpes simplex virus or varicella zoster virus. The standard regimen is intravenous acyclovir for 7 to 10 days followed by oral valacyclovir for several weeks, with intravitreal foscarnet added in severe cases because of the risk of retinal detachment. Ganciclovir targets cytomegalovirus, methotrexate suits intraocular lymphoma, and steroids alone would worsen viral replication.

Reference: Yanoff and Duker Ophthalmology, 5th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.