HIV / AIDS

  • Infection with the human immunodeficiency virus (HIV) that may cause acquired immunodeficiency disease syndrome (AIDS)
  • Systemic manifestations based on immune reaction to virus and infections arising from immune-compromised state
  • Most common ophthalmic manifestations: cotton wool spots ("HIV retinopathy") and retinal necrosis from cytomegalovirus, herpes simplex virus, or herpes zoster virus ("herpesvirus retinopathy")
  • Less common ophthalmic manifestations: retinal, uveal, optic nerve infections from syphilis, toxoplasmosis, cryptococcosis
  • Vision loss if lesions are large, lie near fovea, or in optic nerve
  • Cotton wool spots, reflecting immune reaction to virus
  • Retinal necrosis sometimes starting in periphery, reflecting herpesvirus infection
  • Vitreous clouding from spread of retinal or uveal inflammation
  • Optic neuropathy, with or without optic disc edema, reflecting infection by herpesviruses, syphilis, toxoplasma, cryptococcus, other organisms
  • Cotton wool spots merely reflect retinal microvascular occlusive disease, caused by many other conditions
  • In severe body trauma and pancreatitis, think of Purtscher retinopathy
  • Retinal necrosis can be mimicked by uveitis, endophthalmitis
  • Refer to ophthalmologist any patient with HIV/AIDS who has visual symptoms or low CD4 count or high viral load
  • Cotton wool spots usually disappear spontaneously, leaving behind tiny areas of retinal infarction not noticeable to patient unless very large or close to fovea
  • If disease controlled, no further ophthalmic problems occur
  • In severe disease, herpesvirus retinopathy may destroy retina within weeks, so...
  • Intravitreal and systemic antiviral treatment are critical to halt disease
  • Other infections must be diagnosed and treated appropriately to preserve vision