HIV infection and eye changes
Last reviewed: 23.04.2024
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In patients with acquired immunodeficiency against a background of other lesions, generalization of cytomegalovirus infection usually reveals chorioretinitis.
Visual impairment may be the first symptom of not only a manifest cytomegalovirus infection, but also the onset of AIDS.
Detection of retinitis in the early stages is possible with a regular and complete ophthalmological examination of both eyes. Early treatment can prevent retinal ruptures that develop in 15-29% of patients with progression of atrophy and thinning of retinal tissue.
At the beginning of the disease, patients can complain about the vagueness of the outlines of objects, flashing "flies" in front of one eye, and with the progression of infection, the second eye also develops.
In ophthalmological examination, a white retina necrosis zone with edema and hemorrhages in the surrounding retina tissue is detected, with obstruction of the vessels and infiltration of their walls. In HIV-infected patients, retinal lesions, reminiscent of cytomegalovirus, but caused by other pathogens, are possible.
Toxoplasmosis retinitis in HIV infection is manifested by a large number of white and yellow foci that rise above the retina surface, which resemble flakes. They have fuzzy edges and are localized in the back. There is almost never a hemorrhage. More than 50% of AIDS patients have so-called vaginal spots - superficial lesions of the retina without hemorrhage. When ophthalmoscopy, they resemble fluffy flakes, as in diabetes, hypertension, systemic collagenoses, anemia, leukemia. Unlike cytomegalovirus retinitis, these spots do not increase, often spontaneously regress and never cause significant visual impairment.
Candida retinitis in HIV infection is usually combined with changes in the vitreous body and can result in the development of endophthalmitis.
Herpetic retinitis caused by the herpes simplex virus and the Varicella zoster virus against HIV infection is manifested by acute progressive necrosis of the retina in the form of clearly delineated fields. Herpetic lesions cause retinal destruction and blindness much faster than cytomegalovirus retinitis. Acute retinal necrosis caused by the Varicella zoster virus often begins at the periphery of the retina and quickly seizes all of its tissue, despite powerful therapy. Therapy using various antiviral drugs is almost always unsuccessful.
Syphilitic eye damage in HIV infection is manifested by papillitis and chorioretinitis. The pathological process captures large areas of the retina, on which there are many point infiltrates. The main disease and accompanying infections are treated. Local therapy is symptomatic.
Meningitis, encephalitis, focal inflammatory and tumor processes in the brain always cause eye symptoms: a change in pupillary response, characteristic drop-out of visual fields, congestive discs and neuritis of the optic nerves, paresis and paralysis of the oculomotor nerves, etc.
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