Ocular manifestations with cytomegalovirus (CMV), Toxoplasma, Candida albicans, Cryptococcus, herpes simplex virus, varicella zoster virus, Mycobacterium avium-intracellulare, and Mycobacterium tuberculosis have been reported in association with acquired immunodeficiency syndrome (AIDS).1 CMV retinitis is by far the most common cause of vision loss in these patients.1
CMV retinitis has a very characteristic clinical appearance that consists of white granular lesions with without associated retinal hemorrhages (Fig 1). Lesions with hemorrhage have been described as resembling a "pizza pie." Retinal lesions without hemorrhage appear as white granular infiltrates that at times may be difficult to distinguish from cotton-wool spots. Cotton-wool spots, which are focal areas of infarction of the nerve fiber layers, are the most common ophthalmic manifestation of AIDS.1 Infarcts of the nerve fiber layer are also commonly seen in association with diabetes and hypertension. Unlike lesions in CMV retinitis, which progressively enlarge, cotton-wool spots in AIDS patients