While CMV retinitis is the most common ocular complication of AIDS leading to visual impairment and blindness, it is by no means the only eye disease seen with HIV infection. Also important are a variety of opportunistic infections occurring in HIV-positive patients, due to such uncommon or unusual microorganisms as Mycobacterium tuberculosis, atypical mycobacteria, Herpes simplex types I and II, varicella-zoster, toxoplasmosis, histoplasmosis, syphilis, candida, cryptococcus, and microsporidia. Since many of these are not frequently seen in clinical practice and their presentations may be atypical in the immune-compromised patient, it is important for the vision care professional to constantly be aware of the possibility of HIV infection and exercise a high index of suspicion for its presence in individuals at risk for AIDS.
Many of the medical problems that occur in the HIV-positive individual can impact the eye. These include HIV-related ischemic microvasculopathy, toxic or allergic reactions to AIDS medications, unusual neoplasms such as Kaposi’s sarcoma and Burkitt’s lymphoma, and neuro-ophthalmic disorders including toxoplasmosis, tertiary syphilis, and progressive multifocal leukoencephalopathy (PML).
The therapeutic partnership advocated by Healthy Sight Counseling between medical professionals and the vision care professional plays a major role in the management of the HIV-positive individual. AIDS is a systemic process and there is often overlap between the treatment of its ocular and its systemic manifestations. And since the ocular complications of AIDS are so frequent, they may occasionally be the presenting finding in HIV infection, so that it is sometimes the vision care professional who first suggests the diagnosis.