CMV retinitis


  • Most frequent and serious ocular opportunistic infection
  • Leading cause of blindness in AIDS patients
  • Typically occurs with CD4 less than 50

Clinical Features

Fundus photograph of CMV retinitis
  • Variable, but may include:
  • Fundoscopy:
    • Fluffy white perivascular lesions
    • Dirty white granular retinal necrosis
    • Adjacent hemorrhage - "Pizza pie" appearance

Differential Diagnosis

Acute onset flashers and floaters

HIV associated conditions


  • CD4 typically < 50 cells/mm³



Severe Vision Threatening

  • Ganciclovir intraocular implant for 8 months AND
    • Valganciclovir 900mg PO q12hrs x 14 days FOLLOWED BY 900mg PO q24hrs x 7 days

Peripheral lesions

  • Valganciclovir 900mg PO q12hrs x 21 days FOLLOWED BY 900mg PO q24hrs x 7 days


  • Retinal detachment
  • Complete vision loss
    • Despite treatment, 10% lose vision
  • CMV Immune Recovery Uveitis (IRU)
    • Patients with retinitis who develop blurry vision after starting HAART need ophtho eval to assess for CMV progression, relapse, or IRU
    • Possible cause - T-cell mediated immune reconstitution to latent CMV intraocular antigens
    • Symptoms - Floaters, photophobia, blurred vision
    • Occurs median 20 weeks after starting HAART
    • Urgent ophtho eval


See Also


  1. Gutteridge, David L MD, MPH, Egan, Daniel J. MD. The HIV-Infected Adult Patient in The Emergency Department: The Changing Landscape of the Disease. Emergency Medicine Practice: An Evidence-Based Approach to Emergency Medicine. Vol 18, Num 2. Feb 2016.
  • Rothmans RE, Marco CA, Yang S. Human immunodeficiency virus infection and acquired immunodeficiency syndrome, in Tintinalli JE, Stapczynski JS, Ma OJ, et al (eds): Tintinalli’s Emergency Medicine, ed 7. New York, The McGraw-Hill Companies Inc., 2011.