Eye
HIV Retinitis
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HIV Retinitis
, CMV Chorioretinitis, CMV Retinitis
Epidemiology
Most common HIV ocular complication
Etiologies
Most Common Retinitis Etiology
Cytomegalovirus
Chorioretinitis
Other causes
Varicella Zoster Virus
Pneumocystis carinii
Toxoplasma gondii
Risks
CD4 Count
< 100
Confers 20% CMV Retinitis risk in 2 years
Usually occurs when
CD4 Count
< 50
Invasive
Cytomegalovirus
confers 90% retinitis risk
Symptoms
Vision
changes (usually unilateral)
Painless
Blurred Vision
Floaters
in
Visual Field
Light Flashes
Scotoma
Signs
Focal Necrotizing Retinitis
Retina
l
Hemorrhage
, exudation, edema
Opaque lesions with patchy
Hemorrhage
and
Vasculitis
Ischemic
Retinopathy
Cotton wool spots (areas of ischemic infarction)
Usually no
Hemorrhage
or edema
Course
Disease progresses rapidly
Irreversible blindness in 2 weeks if not treated
Recurrence of CMV Retinitis
Inevitable despite treatment (foscarnet, ganciclovir)
Median 3-4 months (days-weeks without treatment)
Ganciclovir implants may delay for 7 months
Complications
Retinal Detachment
with sudden loss of
Vision
Monitoring
Ophthalmology exam every 6 months (
CD4 Count
<100/mm3)
Ophthalmology exam every 3 months (
CD4 Count
<50/mm3)
Management
Treat Retinitis immediately to prevent blindness
See
Cytomegalovirus
for treatment
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