Snap Shot A 38-year-old HIV positive man presents with painless vision loss. His last CD4+ count was 48. Introduction An infection of the retina by CMV Seen most commonly in HIV positive patients with CD4+ counts < 50 these patients are also at risk for HSV retinitis which presents similarly but is associated with eye pain Presentation Symptoms painless vision loss Evaluation Fundoscopy yellowish-white patches of retinal opacification note that in HSV retinitis the findings include peripheral lesion and central necrosis of the retina Differential HSV retinitis, varciella zoster Treatment Medical valgancyclovir