Ocular manifestations of cytomegalovirus in immunocompetent hosts

This review highlights recent studies that have increasingly implicated cytomegalovirus (CMV) as a significant cause of keratouveitis and retinitis in immunocompetent hosts.

Molecular testing has identified that CMV infection is frequently present in cases of Posner-Schlossman and Fuchs, keratouveitis syndromes previously presumed to be idiopathic conditions. Ocular hypertension and endothelial cell loss are important complications of CMV keratouveitis and are likely mediated by viral invasion of the trabecular meshwork and corneal endothelium. Topical ganciclovir is a well tolerated, effective, and economical therapy. CMV retinitis is possible in the absence of HIV/AIDS.

CMV has long been considered an innocuous infection in the general population, though recent studies have found otherwise. Intraocular reactivation, replication, and invasion of the trabecular meshwork and endothelium lead to recurrent bouts of ocular hypertension and endothelial cell loss, the complications of which may be tempered with initiation of antivirals. Topical ganciclovir is a promising therapy that needs investigation. CMV retinitis, an entity previously believed isolated to the severely immunosuppressed population, has been reported on numerous occasions in presumably immunocompetent individuals, particularly following local steroid injections. Further studies may elucidate the pathogenesis of CMV in immunocompetent populations.