When it comes to HIV and AIDS, one of the most commonly overlooked symptoms is that affecting the eyes. While it is not necessarily a major issue for all people with HIV or AIDS, understanding and recognizing signs of eye problems can help ensure that those affected get the care and treatment they need.
HIV and AIDS
HIV (human immunodeficiency virus) is the virus that can cause AIDS (acquired immunodeficiency syndrome) if HIV is not properly treated. HIV attacks the body’s immune system, which helps fight off infections. Over time, HIV weakens the body’s ability to fight off serious infections (opportunistic infections) and some cancers. When this happens, HIV infection becomes AIDS, the advanced stage of the disease. Unlike some other viruses, the human body can’t get rid of HIV completely, even with treatment. So once a person gets HIV, they have it for life. With proper medical care, HIV can be controlled.
Acquired Immunodeficiency Syndrome (AIDS) is a disease of the body’s immune system. AIDS is caused by infection with the Human Immunodeficiency Virus (HIV), which attacks the body’s cells, particularly the white cells.
How does HIV affect the eye?
People with HIV can have problems in and around the eye that people without HIV do not get. About 70% of individuals with HIV will have an eye problem. Sometimes these problems can be the first sign that a person has an HIV infection. Those with very weak immune systems are at risk for serious eye diseases that may lead to blindness if not identified and treated promptly. The most common eye problem for people with AIDS is cotton wool spots, a condition characterized by fluffy-looking white spots on the retina that does not threaten vision.
Here are ten of the most common eye symptoms associated with HIV and AIDS:
Immune Recovery Uveitis
This is an inflammation of the middle layer of your eyeball and usually presents itself as redness in the eye, accompanied by sensitivity to light, pain, blurry vision, floaters, or even temporary blindness. It’s a side effect of treatment for up to 60% of people with HIV who’ve had CMV retinitis. As associated with HIV and AIDS, treatment may require steroid drops or ointments to reduce inflammation, as well as other medications such as cyclosporine to prevent a recurrence. If left untreated, uveitis can lead to serious damage to the eyes and permanent vision loss.
Dry Eye Syndrome
About 20% of people with HIV have dry eyes. It occurs when the eyes are not producing enough tears to keep them lubricated, resulting in dryness, discomfort, and even infections due to a lack of protective oils on the eyelids. Blepharitis, an inflammation of the eyelid that’s also common with HIV, can worsen the dryness. Symptoms may include burning, itching, irritation in the eyes, sensitivity to light, and blurred vision. Treatment typically includes artificial tears or ointments to keep the eyes moist and avoid smoke and other irritants. If left untreated, dry eye syndrome can lead to more serious vision problems, such as ulcers or scarring on the white of the eye.
Optic Neuropathy
This condition affects the optic nerve, which connects the eyes to the brain. It is often associated with AIDS and can lead to vision loss if not treated properly. Symptoms may include loss of color perception, blind spots, distorted or blurred vision, and eye pain. Treatment typically involves medications such as corticosteroids to reduce inflammation, as well as antiviral drugs that are specific for HIV. If left untreated, optic neuropathy can cause permanent damage to the eyes and irreversibly impair vision.
HIV Retinopathy
It is the most common eye problem in people with HIV. The retina is the lining at the back of your eye that senses light coming into your eye. The retina has tiny blood vessels that can get blocked or bleed and cause damage. This is damage to your retina (the back layer of your eye), which can cause poor night vision or even complete loss of sight over time if left untreated.
Ocular Mucormycosis
This fungal infection is caused by a group of fungi called mucormycetes. Though this fungal disease, also called rhino-orbital mucormycosis, is uncommon in patients with AIDS, it can be very serious if left untreated. Symptoms may include redness, pain, blurred vision, and eye discharge. Treatment typically involves antifungal medications to reduce the severity of the infection. Left untreated, it can lead to complications such as ulcers on the cornea or permanent vision loss in the affected eye.
Conjunctivitis
Also known as “pink eye,” this infection causes swelling, redness, and discharge from one (or both) eyes, accompanied by itchiness and burning sensations when you blink or rub them too hard (which you should never do).
Glaucoma
This condition increases pressure on the optic nerve, eventually leading to permanent vision loss if left untreated (so getting regular checkups from an ophthalmologist is important). Symptoms include headaches, pain around your eyes, trouble adjusting from bright light into darkness quickly, halos around lights at night, etc.
Herpes zoster ophthalmicus (HZO)
HZO is a common infection caused by the reactivation of the chickenpox virus. It can occur in older adults (60+) or younger people living with HIV. HZO can occur anywhere in the body, most commonly on the face and eyes. HZO causes a blistering and crusty rash to defined areas of the body. It can damage the eyes, causing pain and loss of vision. Squamous cell carcinoma of conjunctiva: Squamous cell carcinoma of the conjunctiva is cancer on the eye’s surface. It is more commonly seen in people with HIV/AIDS infection.
Cytomegalovirus (CMV) retinitis
Some people with AIDS develop a serious retinal infection caused by Cytomegalovirus (CMV). There is no cure for CMV retinitis. However, early detection can slow its progression. If left untreated, it can result in retinal detachment and serious vision loss.
Kaposi’s Sarcoma
AIDS can also cause Kaposi’s sarcoma (KS), a vascular tumor that grows on the eyelid or white of the eye.
These are just some of the potential symptoms associated with HIV/AIDS-related eye infections; however, there may be others, so make sure you talk with a healthcare provider if any changes occur concerning their vision so that appropriate treatments can be started right away!
How are AIDS-related eye diseases diagnosed?
Your eye care provider will ask about your symptoms and medical history and do exams and tests such as:
- An exam using a microscope with a light attached, called a slit lamp, to look closely at the front and back of your eye.
- An exam using drops to enlarge or dilate your pupils and a light to look into the back of your eyes
- An eye test in which a camera takes pictures of the blood vessels inside your eye after the dye is injected into a vein in your arm.
- A visual field test, which uses spots of light to measure your central vision and how well you see things on all sides
What are the symptoms?
Symptoms may include:
- Floating spots in your vision or loss of vision
- Problems with eye movement
- A bright red or purple growth near the corner of the eye
- Blurry vision, double vision, or changes in color vision
- Painful, red, or watery eyes
- Painful sensitivity to light
- Swollen eyelids or fluid-filled blisters on or inside your eyelids
How are HIV-related vision problems diagnosed?
A person with HIV should have yearly comprehensive eye exams with an eye doctor. Because of the increased risk of eye problems, people with compromised immune systems may need to see an eye doctor more often, like every three months.
During a comprehensive eye exam, the eye doctor will conduct the following tests, among others:
- Visual acuity: This test will determine how well you can see through your central vision in each eye. This is the part of the exam when you read an eye chart to see how clearly you see.
- Dilated eye examination: The eye doctor will dilate (widen) the pupils of the eyes with eye drops to allow a better view of the back of your eyes (retina and macula).
How is it treated?
Treatment for HIV-related eye problems depends on the specific vision problem.
- Medicines can help treat infections.
- Tumors may be treated with radiation or surgery.
- Retina damaged by bleeding and swelling inside the eye may need eye injections, surgery, or laser treatment.
Individuals should discuss their treatment options with their eye care provider and seek out the treatment that will meet their personal and lifestyle needs. A person with HIV who maintains a healthy immune system by taking antiviral drug treatments as recommended is at a lower risk of developing HIV-related eye diseases.
Increased risk of various eye infections
Some eye infections may be more common in patients with HIV. These infections include:
- syphilis
- herpes virus
- gonorrhea
- Chlamydia
- toxoplasmosis
- Candida
- Pneumocystis
- microsporidia
These infections can threaten vision and must be treated by an ophthalmologist.
Protect Eye Health
Don’t wait for symptoms to appear to see your eye doctor. Get regular checkups. Some HIV-related eye infections don’t always have outward signs early on, but they can still lead to vision loss. HIV can also mean you get age-related changes, such as cataracts, at an earlier age than usual. Regular eye exams can spot them early.
How often to see your eye doctor depends on your health. For example, once a year might be enough if your HIV is under control, but you may need to go every three months if your CD4-T cell count is low. A low count plus a high viral load means a stronger chance of eye problems.
Between visits, call your doctor if you notice:
- Blurriness or double vision
- Seeing floaters, blind spots, or flashes
- Eye pain
- Sensitivity to light
- Watery eyes
- Changes in how you see color
References:
https://www.uclahealth.org/medical-services/ophthalmology/eye-conditions/hiv-related-eye-problems
https://preventblindness.org/hiv-aids-and-the-eye/
https://www.webmd.com/hiv-aids/hiv-eyes
