HIV infection and eye changes

In patients with acquired immunodeficiency, against the background of other lesions, chorioretinitis is usually detected during generalization of cytomegalovirus infection.

Visual impairment may be the first symptom not only of manifest cytomegalovirus infection, but also of incipient AIDS.

Early detection of retinitis is possible with regular and complete ophthalmological examination of both eyes. Early treatment can prevent retinal tears, which develop in 15-29% of patients with progression of atrophy and thinning of the retinal tissue.

At the beginning of the disease, patients may complain of blurred outlines of objects, flickering "flies" in front of one eye, and as the infection progresses, the second eye also becomes ill.

Ophthalmological examination reveals a white retinal necrosis zone with edema and hemorrhages in the surrounding retinal tissue, with vascular occlusion and infiltration of their walls. HIV-infected patients may have retinal lesions resembling cytomegalovirus, but caused by other pathogens.

Toxoplasmosis retinitis in HIV infection is manifested by a large number of white-yellow foci rising above the surface of the retina, which resemble flakes. They have unclear edges and are localized in the posterior section. Hemorrhage is almost never observed. More than 50% of AIDS patients develop so-called cotton-wool spots - superficial retinal lesions without hemorrhage. With ophthalmoscopy, they resemble fluffy flakes, as in diabetes mellitus, hypertension, systemic collagenoses, anemia, leukemia. Unlike cytomegalovirus retinitis, these spots do not increase in size, often spontaneously regress and never cause significant visual impairment.

Candidal 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 the background of HIV infection manifests itself as acute progressive retinal necrosis in the form of clearly demarcated 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 affects all of its tissue, despite powerful therapy. Therapy using various antiviral drugs is almost always unsuccessful.

Syphilitic eye disease in HIV infection manifests itself as papillitis and chorioretinitis. The pathological process affects large areas of the retina, where there are numerous point infiltrates. The underlying disease and associated infections are treated. Local therapy is symptomatic.

Meningitis, encephalitis, focal inflammatory and tumor processes in the brain always cause eye symptoms: changes in pupillary response, characteristic visual field loss, congestive discs and neuritis of the optic nerves, paresis and paralysis of the oculomotor nerves, etc.

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