Eye In HIV

INTRODUCTION:
  • Ophthalmologic problems occur in approximately half of patients with advanced HIV infection.
  • Viral, bacterial & fungal infection, Kaposi sarcoma, CMV retinitis, lymphoma are the Ocular manifestation of HIV
  • Central toxoplasma chorioretinitis , CMV retinitis, Candida endophthalmitis are the ocular lesions may occur in patients suffering from
 AIDS
  • The most common abnormal findings on funduscopic examination are cotton-wool spots. (hard white spots that appear on the surface of the retina and often have an irregular 
  • edge.) 
  • They represent areas of retinal ischemia secondary to microvascular disease.
  • One of the most devastating consequences of HIV infection is CMV retinitis.
  • The majority of cases of CMV retinitis occur in patients with a CD4 + T-cell count < 50/uL.
  • Therapy for CMV retinitis consists of intravenous ganciclovir or foscarnet, with cidofovir as an alternative.
  • Both HSV and varicella zoster virus can cause a rapidly progressing, bilateral necrotizing retinitis referred to as the 'Acute Retinal Necrosis Syndrome'.
CHORIORETINITIS:
  • CMV retinitis is the most frequent and serious ocular opportunistic infection and is the leading cause of blindness in AIDS patients.
  • In early stages retinitis may be asymptomatic, but later causes changes in visual acuity, visual field cuts, photophobia, scotoma, and eye redness or eye pain. 
  • Indirect ophthalmoscopy shows fluffy white perivascular lesions with areas of hemorrhage within them. 
  • Treatment includes intraocular ganciclovir implants, in conjunction with oral ganciclovir.
  • Alternative first-line therapy is ganciclovir without implants for 14 to 21 days.
Exam Question
  • MV retinitis is the most frequent and serious ocular opportunistic infection and is the leading cause of blindness in AIDS patients. 
  • Viral, bacterial & fungal infection, Kaposi sarcoma, CMV retinitis, lymphoma are the Ocular manifestation of HIV 
  • Commonest opportunistic organism to cause ocular inflammation in AIDS is Cytomegalovirus
  • Central toxoplasma chorioretinitis , CMV retinitis, Candida endophthalmitis are the ocular lesions may occur in patients suffering from AIDS
  • Vision loss in HIV is commonly due to infection with Cytomegalovirus
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