A 25 year old male presents with painless sudden loss of vision, ocular and systemic examination is not contributory. What is probable diagnosis –
**Core Concept:** Acute retinal necrosis (ARN) is a severe form of herpes simplex virus (HSV) infection affecting the retina, often causing necrotizing retinitis. It is usually associated with HIV infection or immunosuppressive therapy.
**Why the Correct Answer is Right:** ARN is caused by the reactivation of latent HSV infection in dorsal root ganglia, which then disseminates along sensory nerves to the retina. The virus targets retinal cells and leads to necrosis and inflammation, resulting in painless vision loss.
**Why Each Wrong Option is Incorrect:**
A. Optic neuritis: This condition usually presents with pain on eye movement, visual field defects, and papilledema. ARN, on the other hand, presents with painless vision loss.
B. Central retinal artery occlusion: This is a sudden occlusion of the central retinal artery leading to acute visual loss. ARN presents with painless vision loss.
C. Vitamin A deficiency: This condition is characterized by night blindness and photophobia, not painless vision loss.
D. Retinitis pigmentosa: This is a genetic disorder causing progressive night blindness and visual field loss, not painless vision loss.
**Clinical Pearl:** The painless sudden loss of vision in a young patient with no significant associated symptoms should raise suspicion for ARN, particularly in those with risk factors like HIV infection or immunosuppressive therapy.
**Correct Answer:** C. Central serous choroidal effusion (CSC) is the correct answer. CSC is a condition characterized by subretinal fluid accumulation, leading to serous detachment of the neurosensory retina, causing painless visual loss. The other options are not associated with painless sudden vision loss in the absence of significant ocular or systemic symptoms.