What is the leading cause of blindness in patients with AIDS?

• A. Cytomegalovirus
• B. Toxoplasmosis retinochoroiditis
• C. Herpetic retinitis
• D. Varicella-zoster retinitis

Answer: (A)

Cytomegalovirus retinitis is the one to know here. In patients with AIDS, severe immune suppression allows CMV to reactivate and infect the retina, producing necrotizing retinitis with vascular inflammation. This process gradually destroys retinal tissue and can lead to retinal detachment and irreversible vision loss if not treated. The classic appearance is a necrotizing retinitis with hemorrhages along the vessels, sometimes described as a “pizza pie” pattern, reflecting the combination of inflamed retina and lipid-rich exudates. While toxoplasma, herpesviruses, and varicella-zoster can cause ocular disease in AIDS, none are as commonly the primary cause of blindness as CMV retinitis, making CMV the leading opportunistic sight-threatening infection in this population.