Anterior segment manifestations of human immunodeficiency virus/acquired immune deficiency syndrome

Abstract

Ocular complications are known to occur as a result of human immunodeficiency virus (HIV) disease. They can be severe leading to ocular morbidity and visual handicap. Cytomegalovirus (CMV) retinitis is the commonest ocular opportunistic infection seen in acquired immune deficiency syndrome (AIDS). Though posterior segment lesions can be more vision-threatening, there are varied anterior segment manifestations which can also lead to ocular morbidity and more so can affect the quality of life of a HIV-positive person. Effective antiretroviral therapy and improved prophylaxis and treatment of opportunistic infections have led to an increase in the survival of an individual afflicted with AIDS. This in turn has led to an increase in the prevalence of anterior segment and adnexal disorders. Common lesions include relatively benign conditions such as blepharitis and dry eye, to infections such as herpes zoster ophthalmicus and molluscum contagiosum and malignancies such as squamous cell carcinoma and Kaposi′s sarcoma. With the advent of highly active antiretroviral therapy, a new phenomenon known as immune recovery uveitis which presents with increased inflammation, has been noted to be on the rise. Several drugs used in the management of AIDS such as nevirapine or indinavir can themselves lead to severe inflammation in the anterior segment and adnexa of the eye. This article is a comprehensive update of the important anterior segment and adnexal manifestations in HIV-positive patients with special reference to their prevalence in the Indian population.

Herpes simplex keratitis-induced endophthalmitis in a patient with AIDS with disseminated tuberculosis

“…Varicella zoster virus (VZV) and HSV are the most common aetiological agents of infectious keratitis 16. HSK results from an infection with the HSV type 1 (HSV 1) 17.…”

“…HSV keratitis is usually followed by symptoms such as corneal scarring, iritis and raised IOP. Corneal involvement has been reported infrequently in individuals with AIDS or other immunosuppressed status 16 18. Holland et al classified HSV keratitis into four categories: (1) infectious epithelial keratitis which is made up of cornea vesicles, dendritic ulcer, geographic ulcer and marginal ulcer, (2) neurotrophic keratopathy, (3) stromal keratitis and (4) endotheliitis.…”

Infections of the Eyelids

“…Kaposi's sarcoma of the eyelid appears as multiple purple to red nodules [ 54 ]. It can mimic a chalazion.…”

Eyelid problems in general practice

“…4 Most cases are seen in immunocompetent children, although an increasing number of cases now occur in immunocompromised patients of all ages. In immunocompetent patients, the pale, waxy, umbilicated nodules typically occur unilaterally, and are smaller in size and fewer in number.…”

“…The lesions often recur in patients with advanced human immunodeficiency virus (HIV) infection, although the initiation of antiretroviral therapy may lead to complete resolution of disseminated disease. 4 Therefore, it is important to consider the possibility of compromised immunity in a patient who presents with atypical molluscum contagiosum.…”