Ocular Manifestations of AIDS

These occur in about 75
percent of patients and sometimes may be the
presenting features of AIDS in an otherwise healthy
person or the patient may be a known case of AIDS
when his eye problems occur. Ocular lesions of AIDS
may be classified as follows:
1. Retinal microvasculopathy. It develops from
vaso-occlusive process which may be either due to
direct toxic effects of virus on the vascular
endothelium or immune complex deposits in the
precapillary arterioles.
It is characterised by non-specific lesions (Fig.
19.9):
Multiple ‘cotton-wool spots’ occur in 50 percent
cases,
Superficial and deep retinal hemorrhages occur in
15-40 percent cases.
Microaneurysms and telangiectasia may also be
seen rarely.
2. Usual ocular infections. These are also seen in
healthy people, but occur with greater frequency and
produce more severe infections in patients with AIDS.
These include:
Herpes zoster ophthalmicus,
Herpes simplex infections,
Toxoplasmosis (chorioretinitis),
Ocular tuberculosis, syphilis and fungal corneal
ulcers.
3. Opportunistic infections of the eye. These are
caused by microorganisms which do not affect normal
patients. They can infect someone whose cellular
immunity is suppressed by HIV infection or by other
causes such as leukaemia. These include:
cytomegalovirus (CMV) retinitis (see page 253 Fig
11.5), candida endophthalmitis, cryptococcal
infections and pneumocystis carini, choroiditis.
4. Unusual neoplasms. Kaposi’s sarcoma is a
malignant vascular tumour which may appear on the
eyelid or conjunctiva as multiple nodules. It is seen
in about 3 percent cases of AIDS. Burkitt’s lymphoma
of the orbit is also seen in a few patients.
5. Neuro-ophthalmic lesions. These are thought to
be due to CMV or other infections of the brain. These
include isolated or multiple cranial nerve palsies
resulting in paralysis of eyelids, extraocular muscles,
loss of sensory supply to the eye and optic nerve
involvement causing loss of vision.
Management. It consists of the measures directed
against the associated infection/lesions. For example:
CMV infections can be treated by zidovudine,
gancyclovir and foscarnet (see page 422).
Kaposi’s sarcoma responds to radiotherapy.
Horpes zoster ophthalmicus, is treated by
acyclovir.