In human immunodeficiency virus-infected children, cytomegalovirus causes retinitis alone, with dissemination, or with immune reconstitution inflammatory syndrome. We describe 6 severely immunosuppressed African children (median age, 6.7 months) with cytomegalovirus disease. Of the 6 children, 5 had clinical features suggesting ocular disease at presentation. The child in whom retinitis was detected through preemptive screening due to systemic disease achieved normal visual outcome.