Cytomegalovirus retinitis

Causes

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

Some people 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.

Exams 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).

Outlook (Prognosis)

The disease will sometimes get worse, even with treatment.

Possible 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

When to Contact a Medical Professional

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.

Prevention

 A CMV infection usually only causes symptoms in people with a weakened immune system. Certain medicines (like cancer therapy) and diseases (such as AIDS) can cause a weakened immune system.

People with AIDS who have a CD4 count of less than 100 should be examined regularly for this condition, even if they do not have symptoms. If you had CMV retinitis in the past, you should take preventative treatment for this condition even if your CD4 count stays below 100. If your count has been about 100 for 3-6 months, your doctor  may say you can safely stop the preventative treatment.

Alternative Names

CMV retinitis

References

Drew WL. Cytomegalovirus. In: Goldman L, Schafer AI, eds.Cecil Medicine. 24th ed.Philadelphia,PA: Saunders Elsevier; 2011:chap 384.

Masur H, Healey L, Hadigan C. Treatment of human immunodeficiency virus infection and acquired immunodeficiency syndrome. In: Goldman L, Schafer AI, eds.Cecil Medicine. 24th ed.Philadelphia,PA: Saunders Elsevier; 2011:chap 396.

Update Date: 12/6/2011

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.