Ophthalmological Signs of AIDS

1. Noninfectious retinopathy:

(a) cotton-wool spots

(b) retinal haemorrhages

(c) microvascular changes.

2. Opportunistic infections:

(a) Involvement of posterior segment:

• CMV retinitis

• acute retinal necrosis (herpes simplex, herpes zoster)

• toxoplasmic chorioretinitis

• Pneumocystis carinii choroiditis

• tuberculous choroiditis

• endophthalmitis caused by Candida albicans - usually intravenous drug users

• cryptococcus chorioretinitis

• syphilitic retinitis

(b) Involvement of anterior segment:

• chronic keratitis and keratouveitis caused by herpes zoster and herpes simplex

• keratoconjunctivitis caused by CMV, microsporum and gonococcus

• corneal ulcer caused by Candida albi-cans, and bacteria (Pseudomonas aeruginosa, Staphylococcus aureus, and Staphylococcus epidermidis)

• syphilitic and toxoplasmic iridocyclitis

• conjunctivitis caused by CMV,herpes zoster and herpes simplex

• bacterial conjunctivitis.

3. Neoplasms:

(a) conjunctival, palpebral and orbital

Kaposi's sarcoma

(b) intraocular lymphoma

(c) other neoplasms:

• conjunctival squamous carcinoma

• palpebral and orbital lymphoma.

4. Neuro-ophthalmological signs:

(a) Involvement of cranial nerves:

• internuclear ophthalmoplegia

• third, fourth and sixth cranial nerve palsies

• retrobulbar neuritis and papillitis

(b) Homonymous haemianopia

(c) AIDS-dementia complex with cortical blindness.

5. Other signs:

(a) Conjunctiva:

• nonspecific conjunctivitis

• keratoconjunctivitis sicca

• nonspecific conjunctiva micro-vascular changes in the inferior perilimbal bulbar region (haemorrhages, microaneurysms, column fragmentation, dilatation and irregular vessel diameter)

• bacterial conjunctivitis

• nonspecific punctate keratitis

• necrotising scleritis.

• talc-induced retinopathy (only intravenous drug users)

• herpes zoster ophthalmicus

• palpebral molluscum contagiosum

• palpebral cryptococcosis

• orbital apex granuloma

• orbital pseudotumour

• orbital infiltration by Aspergillus, Pneumocystis carinii

• orbital cellulitis

(g) Visual and refraction defects:

• night blindness because of vitamin A and E malabsorption

• progression of myopia

• decreased accommodation

(h) Acute closed-angle (bilateral) glaucoma caused by choroidal effusion.

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