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Home Your Health Multimedia Encyclopedia Cytomegalovirus retinitis

Cytomegalovirus retinitis

Definition

Cytomegalovirus (CMV) retinitis is a viral inflammation of the retina of the eye.

Alternative Names

CMV retinitis

Causes, incidence, and risk factors

CMV retinitis is caused by a member of a group of herpes-type viruses. CMV is very common. Most people are exposed to CMV in their lifetime, but typically only those with weakened immune systems become ill from CMV infection. Serious CMV infections can occur in people who have weakened immune systems due to:

• AIDS
• Bone marrow transplant
• Chemotherapy
• Drugs that suppress the immune system
• Organ transplant

Symptoms

Note: Many patients with CMV retinitis have no symptoms.

Symptoms include:

• Blind spots
• Blurred vision and other vision problems
• Floaters

Retinitis usually begins in one eye, but often progresses to the other eye. Without treatment, progressive damage to the retina can lead to blindness in 4-6 months or less.

Even with regular treatment, the disease can worsen to blindness. This may be because the virus becomes resistant to the drugs so that the drugs are no longer effective, or because the patient's immune system has deteriorated further.

Patients with CMV retinitis also have a chance of developing retinal detachment, in which the retina detaches from the nerves of the eye, causing blindness. Systemic CMV infection also can occur.

Signs and tests

CMV retinitis is diagnosed through a standard ophthalmologic exam. Dilation of the pupils and ophthalmoscopy will show signs of CMV retinitis.

CMV infection can be diagnosed with blood or urine tests that look for substances specific to the infection. A tissue biopsy can detect the viral infection and presence of CMV virus particles, but this is rarely done.

Treatment

The goal of treatment is to stabilize or restore vision and prevent blindness. Long-term treatment is often needed. Medications may be given by mouth (orally), through a vein (intravenously), or injected directly into the eye (intraviteously).

Support Groups

Expectations (prognosis)

The disease will sometimes get worse, even with treatment, because antiviral medications stop the spread of the virus but do not destroy it.

Complications

• Blindness
• Kidney impairment (from drugs used to treat the condition)
• Low white blood cell count (from drugs used to treat the condition)
• Retinal detachment

Calling your health care provider

If symptoms worsen or do not improve with treatment, or if new symptoms develop, call your health care provider.

People with AIDS (especially those with a very low CD4 count) who have vision problems should make an appointment for an immediate eye exam and should consider taking preventive treatment for CMV retinitis.

Prevention

CMV infection that causes symptoms normally occurs only in those with weakened immune systems. People with AIDS who have a CD4 count of less than 100 should be examined regularly for retinitis even if they don't have symptoms.

References

Drew WL. Cytomegalovirus. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 399.