Emergency: requires immediate attention
Cytomegalovirus retinitis - External and Internal Eye
Alerts and Notices
Synopsis
With the introduction of antiretroviral therapy (ART) in 1996, there has been a 75% reduction in the number of new patients with CMV retinitis. Despite this marked decline in incidence, more than 20% of patients respond poorly to ART, are noncompliant, or do not tolerate the regimen. These patients represent a significant population that continues to be at risk for CMV retinitis.
CMV is a double-stranded DNA virus that is ubiquitous in the United States and is easily spread from person to person by direct contact. In healthy people, the virus remains subclinical, but in the immunocompromised, CMV can lead to infections of the lung (pneumonitis), gastrointestinal tract (colitis), brain (encephalitis), and retina (retinitis).
Patients may complain of floaters, blurred vision, or photopsia, but they are often asymptomatic. The retina shows a slowly expanding demarcated area of retinal necrosis and hemorrhage, often near the vasculature. CMV retinitis may respond well to treatment, but it may recur. There is also an increased risk of retinal detachment, which is difficult to repair and can lead to permanent loss of vision.
Immune recovery uveitis can occur in some patients with pre-existing CMV retinitis after a good response to ART therapy. In these patients, vitreitis and optic disc edema can lead to chronic vision-limiting complications, including macular edema and epiretinal membrane.
Codes
ICD10CM:B25.9 – Cytomegaloviral disease, unspecified
SNOMEDCT:
22455005 – Cytomegalovirus retinitis
Look For
Subscription Required
Diagnostic Pearls
Subscription Required
Differential Diagnosis & Pitfalls
- Progressive outer retinal necrosis
- HIV retinopathy
- Branch retinal vein occlusion (BRVO)
- Acute retinal necrosis (eg, herpes zoster ophthalmicus)
- Toxoplasmic retinochoroiditis (toxoplasmosis)
- Primary intraocular lymphoma
- Ocular syphilis
- Herpes simplex virus retinitis
Best Tests
Subscription Required
Management Pearls
Subscription Required
Therapy
Subscription Required
Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
Subscription Required
Last Reviewed:03/26/2019
Last Updated:03/26/2019
Last Updated:03/26/2019
Emergency: requires immediate attention
Cytomegalovirus retinitis - External and Internal Eye