Bilateral Retinal Ischemia in a Child with Influenza A: A Case Report

Influenza A can cause extra-pulmonary complications, including ocular manifestations. We present a rare case of extensive bilateral retinal ischemia in a paediatric patient following Influenza A infection, involving acute macular neuroretinopathy (AMN), paracentral acute middle maculopathy (PAMM), and cotton-wool spots. A 10-year-old boy presented with bilateral blurry vision four days after confirmed Influenza A infection. Ophthalmologic evaluation revealed best corrected visual acuity (BCVA) of 20/150 OD and 20/125 OS, with optical coherence tomography (OCT) demonstrating hyperreflective bands in the inner nuclear layer, outer plexiform layer, and outer nuclear layer, consistent with simultaneous AMN and PAMM. Cotton-wool spots were also present. The patient was treated with intravenous methylprednisolone, followed by oral prednisolone. BCVA improved to 20/20 in both eyes at 10 months, with complete resolution of OCT findings. This case highlights the importance of early ophthalmologic assessment in children with visual symptoms following viral infections and suggests a potential role for corticosteroid treatment in severe post-viral retinal ischemia. Further studies are needed to clarify the efficacy of corticosteroids in such cases.