Common Eye Diseases Associated With HIV/AIDS

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Skin:

  • Molluscum contagiosum of the eyelid
  • Kaposi Sarcoma of the eyelid skin or conjunctiva
  • Herpes zoster ophthalmicus
  • Herpes simplex the eyelid skin
  • Cornea Dendritic (Herpes simplex) corneal ulcers
  • Fungal corneal ulcers
  • Uvea Anterior uveitis - iritis
  • Posterior uveitis - choroiditis or retinochoroiditis
  • Pan uveitis
  • Vitreous Candida vitritis
  • Retinal vasculitis
  • Cytomegalovirus Retinitis
  • Neoplasia: Kaposi Sarcoma
  • Squamous cell carcinoma
  • Neuro-ophthalmic
  • Intracranial infections by pathogens such as Cryptococcus neoformans and Toxoplasma gondii may cause ocular motor nerve palsies, papillary abnormalities, visual field defects and optic neuropathy

Moluscum Contangiosum

This is a viral infection caused by the cytomegalovirus commonly affecting children. The typical lesion is a pale, waxy elevated nodule on the eyelids.

Clinical Features

Complications
The shedding of cell-laden with viral particles can produce chronic follicular conjunctivitis and superficial keratitis.

Treatment
Expression of the contents of the nodule
Heat cauterisation of the lesions.

Herpes Zoster Ophthalmicus

This is an infection caused by the varicella-zoster affecting the ophthalmic division of the trigeminal vein. It is more common and more severe in patients with lymphomas and those being treated by radiotherapy or immuno-suppressed individuals.

Clinical Features Symptoms

  • Severe pain along the ophthalmic division of the trigeminal nerve VI)
  • Maculopapular rash along the VI that obeys mid facial line.
  • Swelling of the affected part of the face

Signs

  • Typical Herpes Zoster rash

Complications

  • Anterior uveitis
  • Neurological: cranial nerve palsies
  • Optic neuritis
  • Encephalitis
  • Contra-lateral hemiplegia
  • Severe facial skin scarring
  • Corneal opacification
  • Neuropathic keratopathy
  • Disciform keratopathy

Diagnosis
Clinical – the typical distribution of the Herpes Zoster rash

Treatment

  • Oral acyclovir 800mg 5 times daily
  • Oxytetracycline 3% + Hydrocortisone 1% eye drops OR
  • Betamethasone 0.1% + Neomycin 0.5% eye drops OR
  • Dexamethasone 0.1% + Chloramphenicol 1% eye drops 4-6 times daily
  • Calamine lotion to the skin or Acyclovir 3% skin ointment
  • ± systemic steroids (x-ray to rule out PTB) may activate TB in AIDS patients
  • Acyclovir 3% eye ointment 5 times daily.

Cytomegalovirus Retinitis (CMV)

This is a rare chronic diffuse exudative infection of the retina caused by the CMV virus which occurs with rare exception, in patients with an impaired immune system caused by either AIDS, cytotoxic chemotherapy or long term immune suppression following organ  transplantation.

Clinical Features Symptoms

  • Poor vision
  • Floaters

Signs

  • Cotton wool spots
  • Full-thickness retinal necrosis and oedema which starts peripherally or at the posterior pole
  • Retinal bleeding
  • Retinal vasculitis
  • The whole retina eventually involved
  • Total retinal atrophy
  • Retinal detachment

Treatment

  • Dihydroxypropoxymethyl guanine IV causes regression
  • Ganciclovir IV infusion (induction) 5mg/kg 2 times a day for 12-21 days
    • Maintenance dose 5 mg/kg wt daily until adequate recovery of immunity
  • Foscarnet IV infusion, induction 60mg/kg every 8 hours for 2-3 weeks, then maintenance dose 60mg/kg daily increased to 90-120mg/kg if tolerated. If CMW progresses while on the maintenance dose repeat the induction dose. Treatment is needed for life