HIV: EYE PROBLEMS-BLURRED VISION: CYTOMEGALOVIRUS (CMV) RETINITIS
People with HIV infection do not usually have problems with their eyes, and when they do, the problems are often the usual ones that accompany the aging process. But there are some eye problems that indicate serious complications, and a physician must be notified. The most common and serious is cytomegalovirus retinitis. Blurred Vision-Blurred vision, along with several other symptoms and a low CD4 cell count, may indicate an infection of the eye called cytomegalovirus retinitis. Cytomegalovirus (CMV) retinitis-In addition to blurred vision, other symptoms of CMV retinitis can include a blind spot, pain in the eye, and “floaters.” Floaters are spots that float across the line of vision as a result of inflamed cells in the middle of the eye. In many instances the person with CMV retinitis notices no symptoms at all. CMV retinitis is caused by a virus called cytomegalovirus, or CMV, that, like the viruses that cause chickenpox or herpes, infects most people and then remains dormant in the body. Because CMV lives in blood cells, it can circulate to all parts of the body. In this case, CMV has infected the retina, the layer of cells in the back of the eye that, like the film of a camera, is responsible for recording images. The specific symptoms a person has will depend on which area of the retina is affected. CMV retinitis occurs in only 5 to 15 percent of people with HIV infection. It does not occur until the CD4 count is severely lowered. The diagnosis can be made by a physician using an ophthalmoscope, an instrument that permits the physician to see the retina. What part of the retina is infected determines how much vision is lost. On the central part of the retina, where images are focused, a small area of infection can cause complete loss of vision. On the periphery of the retina, a large infection can cause no apparent vision loss. CMV retinitis can occur in one eye or in both eyes. If the infection in one eye is left untreated, it will often affect the other eye as well. If both eyes are infected and left untreated, the usual result is blindness. Loss of sight caused by cytomegalovirus cannot be corrected with glasses. With early treatment, vision can usually be saved before blindness occurs. Treatment is with the antiviral drugs ganciclovir and foscarnet, which slow or stop the progression of the infection. Both drugs are given intravenously, and treatment must continue indefinitely, because the infection recurs when the treatment is stopped.*129\191\2*
