A 65-year-old man presented with new onset cobwebs, floaters, and decreased vision in the right eye. He had underlying diabetes mellitus with known non-proliferative diabetic retinopathy but was otherwise immunocompetent. On dilated fundus examination there was moderate vitritis with sheet like patches of homogeneous peripheral whitening anterior to the equator, consistent with acute retinal necrosis (ARN). There is no visible vitreous traction or retinal tear or detachment. There is also vascular sheathing predominantly of the arterioles, which favors an underlying etiology of varicella zoster virus as the cause of ARN.
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