Retinal examination in patients with HIV should include indirect ophthalmoscopy through a dilated pupil so the entire peripheral fundus can be evaluated. Although some lesions can be seen with a direct ophthalmoscope, direct ophthalmoscopy will only allow visualization of the central portion of the retina, and peripheral lesions will not be seen. Retinal cotton wool spots, intraretinal hemorrhages, and microaneurysms can be seen. These findings are not associated with any particular ocular opportunistic infection and do not have visual consequences. Changes are more common when patients are more severely immunocompromised.
Anemia can produce retinal microangiopathy, which disappears upon normalization of the hemoglobin.
AIDS-related retinal microangiopathy does not require treatment. B. Infectious retinitis and choroiditis Unlike opportunistic infections in other areas of the body, where biopsy is often required to make the diagnosis, retinal and choroidal lesions are usually diagnosed clinically. Ophthalmologists with experience in caring for individuals with HIV infection are familiar with the appearance of many of these entities. At times, when the diagnosis is in doubt, fluid or ocular tissue may be analyzed, but this is rarely done. An experienced observer can diagnose CMV retinitis ophthalmoscopically.