Acute Retinal Necrosis from Reactivation of Varicella Zoster Virus following BNT162b2 mRNA COVID-19 Vaccination

Ocul Immunol Inflamm. 2022 Jul;30(5):1133-1135. doi: 10.1080/09273948.2021.2001540. Epub 2021 Dec 1.


Purpose: To report a case of acute retinal necrosis (ARN) due to varicella zoster virus (VZV) after COVID-19 vaccine administration.

Design/methods: Observational case report.

Result: A 62-year-old immunocompetent African American male presented with left eye redness, decreased vision, and floaters after receiving a COVID-19 vaccine seven days prior. Slit-lamp examination revealed diffuse fine endothelial keratic precipitates. Funduscopic examination was notable for vitreous cells, occlusive retinal vasculitis, large retinal hemorrhages, and three quadrants of peripheral areas of retinal whitening. Quantitative polymerase chain reaction testing was positive for varicella zoster virus in the vitreous humor. Treatment with intravitreal and intravenous antiviral therapy resulted in symptomatic improvement.

Conclusion: COVID-19 mRNA vaccination may cause an immunomodulatory response that leads to reactivation of dormant VZV. Early recognition and treatment can improve visual outcomes.

Keywords: ARN; Acute retinal necrosis; BNT162b2; COVID-19; Pfizer-BioNTech; SARS-CoV2; VZV; vaccine; varicella zoster virus.

Publication types

  • Case Reports

MeSH terms

  • Antiviral Agents / therapeutic use
  • BNT162 Vaccine
  • COVID-19 Vaccines* / adverse effects
  • COVID-19* / prevention & control
  • Herpesvirus 3, Human / genetics
  • Humans
  • Male
  • Middle Aged
  • RNA, Messenger / genetics
  • Retinal Necrosis Syndrome, Acute* / chemically induced
  • Retinal Necrosis Syndrome, Acute* / diagnosis
  • Retinal Necrosis Syndrome, Acute* / drug therapy
  • Vaccination / adverse effects


  • Antiviral Agents
  • BNT162 Vaccine
  • COVID-19 Vaccines
  • RNA, Messenger