Chapter 36
Ocular Manifestations of HIV Infection
EMMETT T. CUNNINGHAM JR. and TODD P. MARGOLIS
Main Menu   Table Of Contents

Search

ADNEXAL MANIFESTATIONS OF HIV INFECTION
ANTERIOR SEGMENT MANIFESTATION OF HIV INFECTION
POSTERIOR SEGMENT MANIFESTATIONS OF HIV INFECTION
ORBITAL MANIFESTATIONS OF HIV INFECTION
NEURO-OPHTHALMIC MANIFESTATIONS OF HIV INFECTION
OCULAR MANIFESTATION OF HIV INFECTION IN CHILDREN
OCULAR MANIFESTATION OF HIV INFECTION IN THE DEVELOPING WORLD
DRUG-RELATED OCULAR TOXICITY IN HIV-INFECTED PATIENTS
REFERENCES

Recent estimates suggest that nearly 1 million persons in the United States and more than 20 million worldwide are infected with the human immunodeficiency virus (HIV).1,2 Ocular manifestations of HIV infection typically occur late in the course of disease, a state referred to clinically as acquired immunodeficiency syndrome (AIDS), and characterized by profound CD4+ T-lymphocyte depletion (less than 200 cells/mm3), or the development of opportunistic infections or unusual neoplasms (Figs. 1 and 2; Table 1).3–5 Since the original description of eye disorders in patients with AIDS by Holland and colleagues6 in 1982, a number of clinic-based surveys7–1617–34 (Table 2) and reviews35–5960–8485–114 have described the spectrum of ocular manifestations in HIV infection. Of note, up to 70% of patients infected with HIV will ultimately develop ocular complications of their disease, most commonly retinal microvasculopathy or cytomegalovirus (CMV) retinitis (see Table 2). Although far less common, other ocular manifestations of HIV infection are well described, and can occasionally cause profound and permanent loss of vision.

Fig. 1. The natural history of HIV Infection. Clinical phases include primary infection, clinical latency, and acquired immunodeficiency syndrome (AIDS). AIDS is characterized by low CD4+ T-lymphocyte counts (less than 200 cells/mm3), high viral titers, and increased susceptibility to opportunistic infections and unusual neoplasms. (Modified from Fauci AS, Pantaleo G, Stanley S, Weissman D: Immunopathogenic mechanisms of HIV infection. Ann Intern Med 124:654, 1996)

Fig. 2. Typical CD4+ T-lymphocyte count range for presentation of various ophthalmic manifestations of HIV infection. Although uncommon, presentation at CD4+ T-lymphocyte counts greater than indicated can occur.

 

TABLE 1. Conditions Included in the Revised 1993 AIDS Surveillance Case Definitions from the Centers for Disease Control3

  Candidiasis of the bronchi, trachea, or lungs
  Candidiasis of the esophagus
  Coiccidioidomycosis, disseminated or extrapulmonary
  Cryptococcosis, extrapulmonary
  Crytptosporidiosis, chronic intestinal (>1 month)
  Cytomegalovirus disease (other than liver, spleen, or lymph nodes)
  Cytomegalovirus retinitis
  Encephalopathy, HIV-related
  Herpes simplex virus, chronic ulcer(s) (>1 month), or bronchitis, pneumonitis, or esophagitis
  Histoplasmosis, disseminated or extrapulmonary
  Isosporiasis, chronic intestinal (>1 month)
  Kaposi's sarcoma
  Lymphoma, Burkitt's (or equivalent term)
  Lymphoma, immunoblastic (or equivalent term)
  Lymphoma, primary central nervous system
  Mycobacterium avium complex or M. kansasii, disseminated or extrapulmonary
  Mycobacterium tuberculosis, any site
  Pneumocystis carinii pneumonia
  Pneumonia, recurrent
  Progressive multifocal leukoencephalopathy
  Salmonella sp. septicemia, recurrent
  Toxoplasmosis of the central nervous system
  Wasting syndrome caused by HIV infection

 

 

TABLE 2. Prevalence of Ocular Disorders in Patients Infected with HIV


StudyHolland et al, 19837Rosenberg et al, 19838Freeman et al, 198410Khadem et al, 198411Palestine et al, 19849Kestelyn et al, 198513Pepose et al, 198512Humphry et al, 198715Fabricius et al, 198816Jabs et al, 198917StudyJabs et al, 198917Dennehy et al, 198918II' nitski et al, 199022Gabriell et al, 199023Kawe et al, 199024Muccioli et al, 199430Seregard, 199431Lewallen et al, 199432Ho et al, 199425Jabs, 199533Maclean et al, 199634
CohortClinic and autopsy (AIDS)Clinic (AIDS)Clinic (AIDS)Clinic (AIDS)Clinic and autopsy (AIDS)Clinic (AIDS)Autopsy (AIDS)Clinic (AIDS)Clinic (HIV)Clinic (AIDS)CohortAutopsy (AIDS)Clinic (AIDS, Children)Clinic (AIDS)Clinic (HIV)Clinic (HIV)Clinic (HIV)Autopsy (AIDS)Clinic (AIDS)Clinic (AIDS)Clinic (AIDS)Clinic (HIV)
CountryUSAUSAUSAUSAUSARwandaUSAUKGermanyUSACountryUSAUSABurundiItalyZaireBrazilSwedenMalawiHong KongUSAAustralia
Sample size30252684029351070200Sample size254213015345445489910781723
Percentage men100769610098621001009992Percentage men9250906287926310088  
Percentage homosexual934492100900941009674Percentage homosexual720 505854 6062 
Total percentage ocular disorders634073506355946043>67Total percentage ocular disorders8420302564523826 >50>50
Retinal microvasculopathy57364238284089503167Retinal microvasculopathy363825641 161050>50
CMV retinitis324151325 34 428CMV retinitis205<83425311503724
VZV/HSV retinitis/ARN  4   3 31VZV/HSV retinitis/ARN     4   <1 
Toxoplasmosis retinochoroiditis         1Toxoplasmosis retinochoroiditis 1  292  <1<1
Syphilitic chorioretinitis          Syphilitic chorioretinitis     <1   <1 
Fungal retinitis          Fungal retinitis4        <1 
Fungal/mycobacterial choroiditis<1     <1 31Fungal/mycobacterial choroiditis8    <1 <1 <1 
Herpes zoster ophthalmicus         4Herpes zoster ophthalmicus  17 18    3 
Kaposi's sarcoma1 4 5 9 63Kaposi's sarcoma    9    21
Molluscum contagiosum        1 Molluscum contagiosum 5      10  
Preseptal cellulitis          Preseptal cellulitis 3         
Conjunctivitis1  13    4 Conjunctivitis    4     <1
Keratitis      3 11Keratitis  3      <1 
Keratoconjunctivitis sicca   13    3 Keratoconjunctivitis sicca           
Papilledema      14 12Papilledema1    2 3 1 
Optic atrophy         3Optic atrophy4  322   <1 
Ocular motility disorder    13  1014Ocular motility disorder         1 
Orbital lymphoma          Orbital lymphoma4          
Orbital cellulitis          Orbital cellulitis         <1 
Retinal vein or artery occlusion          Retinal vein or artery occlusion     <1   2 

ARN, acute retinal necrosis; CMV, cytomegalovirus; HSV, herpes simplex virus; VZV, varicella-zoster virus

 

Back to Top
ADNEXAL MANIFESTATIONS OF HIV INFECTION
Adnexal manifestations of HIV infection are common (Table 3), although they may be the presenting sign of systemic immunosuppression.46,91

 

TABLE 3. Adnexal Manifestations of HIV Infection

  Herpes zoster ophthalmicus
  Kaposi's sarcoma
  Molluscum contagiosum
  Squamous cell carcinoma/conjunctival intraepithelial neoplasia
  Cutaneous lymphoma
  Trichomegaly/Hypertrichosis
  Conjunctival microvasculopathy
  Conjunctivitis
  Preseptal cellulitis

 

HERPES ZOSTER OPHTHALMICUS

Herpes zoster ophthalmicus refers to a varicella-zoster virus (VZV)-related vesiculobullous dermatitis involving the ophthalmic distribution of the trigeminal nerve.115 Although VZV dermatitis may be observed in otherwise normal elderly patients, its occurrence in someone younger than 50 years of age is uncommon, and should raise the suspicion of systemic immunosuppression due to malignancy, pharmacologic immunosuppression, or HIV infection.115–117 VZV dermatitis related to HIV infection typically occurs at CD4+ T-lymphocyte counts of less than 200 cells/μL, and is considered disseminated if it involves multiple dermatomes or unrelated organ systems. Herpes zoster ophthalmicus (Fig. 3) affects approximately 5% to 15% of HIV-infected patients (see Table 2), and in these patients keratitis, scleritis, uveitis, retinitis, or central nervous system involvement may develop.116,117 Treatment involves a 1-week course of intravenous acyclovir (10 mg/kg, three times daily), followed by oral maintenance therapy (800 mg, three to five times daily). Famciclovir (500 mg, three times daily) was approved in 1994 by the US Food and Drug Administration for the treatment of herpes zoster infections offering the advantage of decreased daily dosings. However, the relative efficacy of oral acyclovir versus famciclovir for long-term maintenance therapy in HIV-infected patients is still under study. For patients initially unresponsive to acyclovir, or for those who show reactivation on oral acyclovir or famciclovir, a trial of intravenous foscarnet should be considered.

Fig. 3. Herpes zoster ophthalmicus in a patient with AIDS.

KAPOSI'S SARCOMA

Kaposi's sarcoma is a highly vascularized mesenchymal tumor of the skin and mucous membranes. It occurs in up to 25% of HIV-infected patients, and it is often the presenting sign of disease.118 Kaposi's sarcoma involving the ocular adnexa will develop in approximately 5% of patients infected with HIV.119–121 Both the eyelids and the conjunctiva (Fig. 4) may be involved. Lesions may occur on either the upper or lower eyelid and often mimic a chalazion. Conjunctival lesions are most commonly found in the inferior fornix, but may occur on any aspect of the palpebral or bulbar conjunctiva. Conjunctival Kaposi's sarcoma is often mistaken for benign subconjunctival hemorrhage.

Fig. 4. Inferior conjunctival Kaposi's sarcoma in a patient with AIDS.

Radiation therapy is effective in treating eyelid and conjunctival Kaposi's sarcoma, but it is expensive and can be associated with loss of lashes, skin irritation, and a mild conjunctivitis.122,123 Alternatively, isolated lesions of the eyelid may be treated by cryotherapy or intralesional chemotherapy. Excision can be performed, but is often difficult and complicated by bleeding. Conjunctival lesions also respond to cryotherapy or intralesional chemotherapy, but unlike eyelid lesions, they can be excised with relative ease. Fluorescein angiography is occasionally helpful for identifying a tumor-free margin of 1 to 2 mm at the time of surgery. Eyelid or conjunctival lesions accompanied by systemic involvement are often best treated with systemic chemotherapy. Interferon α has also been used with success. Recurrences are common.124 Recent work has implicated a novel member of the herpes virus family, human herpes virus-8 (HHV-8), in the pathogenesis of Kaposi's sarcoma.125

MOLLUSCUM CONTAGIOSUM

Molluscum contagiosum is a highly contagious papulonodular dermatitis caused by a poxvirus. Both the skin and mucous membranes may be affected, typically with multiple, small, umbilicated lesions. Molluscum contagiosum is more common in HIV-infected patients and, when present, tends to be more severe, producing larger, more numerous, and more rapidly growing lesions.118 Molluscum contagiosum occurs on the eyelids (Fig. 5) in less than 5% of patients infected with HIV (see Table 2).126–129 Although described in the literature, cases of conjunctival molluscum contagiosum are rare. An association with follicular conjunctivitis and superficial keratitis has been described in immunocompetent patients, but appears to be uncommon in HIV-infected persons. Treatment options include cryotherapy, curettage, incision, excision, and topical chemotherapy.

Fig. 5. Periocular molluscum contagiosum in a patient with AIDS.

SQUAMOUS CELL CARCINOMA/CONJUNCTIVAL INTRAEPITHELIAL NEOPLASIA

Patients infected with HIV appear to be at increased risk for conjunctival and eyelid squamous cell carcinoma, possibly associated with human papillomavirus (HPV) infection.130–138 When at the limbus, gonioscopy should be performed to rule out intraocular extension. Treatment consists of wide excision with frozen section monitoring of the margins. A single case of basal cell carcinoma has been reported in a patient with AIDS.65

CUTANEOUS LYMPHOMA

Non-Hodgkin's lymphoma is more common and tends to be of higher grade malignancy in patients infected with HIV.139 There has been one report of a patient with primary eyelid non-Hodgkin's lymphoma.140 Treatment included local radiation therapy.

TRICHOMEGALY

Acquired trichomegaly, or hypertrichosis of the eyelashes (Fig. 6), typically occurs in the late stages of HIV infection.141–147 The cause is unknown, although elevated viral titers, drug toxicity, and poor nutrition have been implicated as contributing factors. Excessively long lashes may be trimmed, as needed, if they interfere with the use of eyeglasses or if the patient finds them cosmetically unacceptable.

Fig. 6. Trichomegaly, or hypertrichosis of the eyelashes, in a patient with AIDS.

CONJUNCTIVAL MICROVASCULOPATHY

Most HIV-infected patients will eventually develop conjunctival microvascular changes, including segmental vascular dilatation and narrowing, microaneurysm formation, the appearance of comma-shaped vascular fragments, and a visible granularity to the flowing blood-column, termed “sludging.”148,149 These changes are usually most evident near the limbus inferiorly (Fig. 7), and are highly correlated with the occurrence of retinal microvasculopathy. The reason for the occurrence of conjunctival microvascular changes in the setting of HIV infection is unknown. Theories have included an HIV-induced increase in plasma viscosity, HIV-related immune complex deposition, and direct infection of the conjunctival vascular endothelium by HIV. No treatment is indicated.46,91

Fig. 7. Conjunctival microvasculopathy at the inferior limbus in a patient with AIDS.

CONJUNCTIVITIS

In one of the first clinic-based cohort studies, Holland and associates7 reported a nonspecific, culture-negative conjunctivitis in 10% of patients with AIDS. More recent clinic-based studies have, however, reported a prevalence of less than 1%, similar to that of the general population (see Table 2). Uncommon infectious forms of conjunctivitis have been reported in HIV-infected patients, including CMV150,151 and Cryptococcus.152 Treatment should be guided by the results of Gram stains and cultures.

PRESEPTAL CELLULITIS

Preseptal cellulitis caused by Staphylococcus aureus has been reported in two HIV-infected patients.18,65 Staphylococcus aureus is the most common cause of cutaneous and systemic bacterial infections in HIV-infected patients, and these patients infected with Staphylococcus aureus have a nasal carriage that is nearly twice that of normal controls.118 Treatment is the same as that used for preseptal cellulitis in immunocompetent patients.

Back to Top
ANTERIOR SEGMENT MANIFESTATION OF HIV INFECTION
Anterior segment findings account for up to 20% of the ocular complications associated with HIV infection, and yet remain unrecognized or undertreated in many patients (Table 4).35,46,91

 

TABLE 4. Anterior Segment Manifestations of HIV Infection

  Keratoconjunctivitis sicca
  Infectious keratitis

  Viral keratitis—herpes zoster virus, herpes simplex virus, cytomegalovirus
  Bacterial and fungal keratitis
  Microsporidial keratitis


  Iridocyclitis
  Angle-closure glaucoma

 

KERATOCONJUNCTIVITIS SICCA

Keratoconjunctivitis sicca, or dry eye, occurs in 10% to 20% of HIV-infected patients, typically at late stages of their illness.153–157 Abnormal Schirmer's testing and interpalpebral rose bengal staining (Fig. 8) are invariably present. The cause is complex, but is most probably related to combined effects of HIV-mediated inflammation and destruction of the lacrimal and salivary glands ( Sjögren's syndrome) and direct HIV infection of the conjunctiva. Concurrent exposure due to lagophthalmos and decreased blink rate in the setting of encephalopathy can worsen the keratopathy. Treatment consists of artificial tears and long-acting lubricating ointments, which are applied at bedtime.

Fig. 8. Interpalpebral rose bengal staining of the conjunctival and corneal epithelium in an AIDS patient with dry eyes.

INFECTIOUS KERATITIS

Infectious keratitis occurs at about the same rate in HIV-infected and HIV-uninfected persons, with most cohorts reporting keratitis in less than 1% of patients (see Table 2). However, when HIV-positive patients do acquire infectious keratitis, the organisms are more likely to be opportunistic, and the course more severe or protracted.35,46,91

VIRAL KERATITIS

Herpes zoster ophthalmicus is often associated with either a dendritic epithelial (Fig. 9) or disciform stromal keratitis in HIV-infected patients. VZV keratitis can, however, also occur with transient or no skin lesions, a condition termed herpes zoster sine herpete and reported to occur rarely in HIV-positive persons.158,159 Decreased corneal sensation and elevated intraocular pressure are clues to the diagnosis. Treatment is similar to that for herpes zoster ophthalmicus, as discussed earlier.

Fig. 9. Conjunctival injection and rose bengal staining of multiple corneal epithelial pseudodendrites in an AIDS patient with herpes zoster keratitis.

Herpes simplex keratitis, in contrast, seems not to be more common in HIV-positive patients.160–163 HIV-associated herpes simplex keratitis may, however, recur more frequently and in some cases be more resistant to treatment than similarly severe cases occurring in immunocompetent patients. At least one case series has suggested that herpes simplex epithelial keratitis may occur more commonly near the limbus, and with more and larger dendrites in HIV-infected patients.160 Treatment includes oral acyclovir (400 mg, five times daily) or topical antivirals.

Wilhelmus and associates164 recently reported an HIV-positive patient with CMV dendritic epithelial keratitis. This patient's disease was resistant to débridement, as well as to standard oral and topical antiviral therapy. The patient died shortly after diagnosis with active keratouveitis.

BACTERIAL AND FUNGAL KERATITIS

Bacterial keratitis and fungal keratitis do not appear to be more common in HIV-positive persons, but when they do occur, they tend to be more severe and have a higher tendency toward perforation.35,46,91 Various reported organisms have included α-hemolytic streptococci, Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, Klebsiella oxytoca, Capnocytophaga sp., and Candida sp.91,165–171 Treatment should be aggressive, with intensive use of fortified antibiotics.

MICROSPORIDIOSIS

Microsporidia are obligate intracellular parasites known to cause gastroenteritis, sinusitis, pneumonitis, and urogenital infections in HIV-infected patients.172 In these patients, ocular infection with microsporidia is uncommon, but when present typically produces a punctate epithelial keratopathy (Fig. 10) with a mild papillary conjunctivitis.173–188 Microsporidia are extremely difficult to culture, but can be readily seen within Geimsa-stained corneal or conjunctival epithelial cells. Treatment options include oral itraconazole, topical propamidine, topical fumagillin, and oral albendazole.

Fig. 10. Superficial punctate epithelial keratopathy caused by microsporidiosis in a patient with AIDS.

IRIDOCYCLITIS

Mild iridocyclitis is common in HIV-infected patients, and most typically observed in the setting of viral retinitis, including CMV retinitis,189,190 VZV retinitis,191–194 and herpes simplex retinitis.195,196 In contrast, more severe anterior chamber inflammation is relatively uncommon in HIV-positive patients. Here too, however, the iridocyclitis is usually secondary to severe posterior inflammation, including toxoplasmosis retinochoroiditis,197–201 syphilitic chorioretinitis,202–217 and bacterial or fungal retinitis or endophthalmitis.218–225 Infectious causes of isolated iridocyclitis have also been described in HIV-positive patients, including toxoplasmosis,226 Cryptococcus,227 syphilis,214,215 and CMV.228 Iridocyclitis may be part of Reiter's syndrome, which may be more common and appears to be more severe in HIV-infected patients.229,230 Lastly, drugs used to treat opportunistic infections in HIV-positive patients, such as rifabutin,231–233 used for Mycobacterium avium complex, and cidofovir234,235 given to treat viral retinitis, can cause severe iridocyclitis. Treatment should be directed toward a specific infectious cause; when toxicity is suspected, the offending drug should be discontinued or the dosage decreased.

ANGLE-CLOSURE GLAUCOMA

Acute angle-closure glaucoma has been described in association with uveal effusion syndrome in HIV-infected patients.236–239 Typically, miotics worsen this condition and peripheral iridotomies have little effect. Anterior choroidal effusions should be either visible or present on ultrasonography. The cause of HIV-associated angle-closure glaucoma is unknown, although uveal effusions can occur in nanophthalmos and ocular axial length should be checked in all patients. Treatment includes cycloplegia, topical corticosteroids, and, when necessary, surgical drainage of suprachoroidal fluid.240

Back to Top
POSTERIOR SEGMENT MANIFESTATIONS OF HIV INFECTION
The majority of ocular manifestation of HIV infection involve the posterior segment of the eye (Table 5). Together, retinal microvasculopathy and CMV retinitis account for more than 80% of the ocular complications in HIV-positive patients (see Table 2). CMV retinitis in particular is by far the single most significant cause of loss of vision in this population, affecting up to 40% of patients (see Table 2).189,190

 

TABLE 5. Posterior segment manifestations of HIV Infection

  Retinal microvasculopathy
  Infectious retinitis

  Cytomegalovirus retinitis
  Varicella-zoster virus retinitis
  Herpes simplex virus retinitis
  Toxoplasmosis retinochoroiditis
  Bacterial and fungal retinitis


  Infectious choroiditis
  Intraocular lymphoma
  Retinal vein or artery occlusion

 

RETINAL MICROVASCULOPATHY

Retinal microvasculopathy occurs in more than 50% of HIV-infected patients (see Table 2). The most commonly observed manifestation is cotton-wool spots (Fig. 11), although intraretinal hemorrhages, microaneurysms,241,242 and, uncommonly, retinal ischemia12,243 also occur. With the exception of retinal ischemia, these findings are transient. All forms of retinal microvasculopathy increase in frequency in more advanced stages of HIV infection.241,242 Hypotheses regarding the pathogenesis of retinal microvasculopathy parallel those suggested for conjunctival vascular changes,149 and include HIVinduced increase in plasma viscosity, HIV-related immune complex deposition, and direct infection of the conjunctival vascular endothelium by HIV. HIV-associated retinal microvasculopathy is typically asymptomatic, but may play a role in the progressive optic nerve atrophy,244,245 electroretinographic abnormalities,246 and loss of color vision, contrast sensitivity, and visual field observed in HIV-infected patients.247,248 The role of retinal microvasculopathy in the development of CMV retinitis is controversial, with some investigators finding no relationship242 and others suggesting that retinal vascular damage may provide increased access to circulating CMV-infected lymphocytes.249

Fig. 11. Retinal microvasculopathy with numerous cotton-wool spots in a patient with AIDS.

INFECTIOUS RETINITIS

Cytomegalovirus Retinitis

CMV retinitis affects 30% to 40% of HIV-infected patients (see Table 2).33,189,190 Any aspect of the fundus may be involved, including the optic nerve head. Affected patients typically report gradual visual field loss or the onset of floaters. Clinical examination shows geographic retinal thickening and opacification. Associated intraretinal hemorrhages are often present (Fig. 12A). Anterior chamber and vitreous inflammation, although invariably observed, are usually minimal. CMV retinitis typically occurs at CD4+ T-lymphocyte counts of less than 50 cells/mm3, and almost always at counts less than 100 cells/mm3. Treatment of CMV retinitis is a complicated, rapidly evolving field.33,189,190 Current FDA-approved treatments for active retinitis include intravenous ganciclovir, foscarnet, and cidofovir. Any of the same medicines or the recently approved oral formulation of ganciclovir can be used for maintenance therapy. Local therapy with intravitreal injection of ganciclovir, foscarnet, or cidofovir, or via implantation of a slow-release ganciclovir-containing reservoir, is also possible. Choice of an appropriate antiviral and route of delivery needs to be individualized, based on consideration of the location and extent of ocular and systemic disease, understanding of potential drug-related side-effects, and knowledge of viral response to past treatments.250–253

Fig. 12. Causes of infectious retinitis, including cytomegalovirus (A), varicella-zoster virus (B), herpes simplex virus (C), and toxoplasmosis (D) in four different patients with AIDS.

Varicella-Zoster Virus Retinitis

VZV is the second most common cause of necrotizing retinitis in HIV-infected individuals, affecting approximately 5% of large cohorts with AIDS (see Table 2).191–194 Like CMV, VZV produces retinal whitening (Fig. 12B), occasionally accompanied by intraretinal hemorrhages. However, VZV retinitis is usually distinguished by its rapid progression, multifocal nature, and initial involvement of deep retinal layers. A concurrent or recent herpes zoster dermatitis provides added circumstantial support for the diagnosis. The risk of retinal detachment is greater than observed with CMV retinitis. Treatment involves the use of intravenous and intravitreal antivirals, typically combination therapy with acyclovir and foscarnet.

Herpes Simplex Virus Retinitis

Herpes simplex virus is a rare cause of retinitis in HIV-infected patients.195,196 Like VZV retinitis, onset of symptoms and disease progression is rapid. Clinical appearance may mimic VZV retinitis (Fig. 12C). Treatment should include prompt use of intravenous and intravitreal antivirals, again most typically acyclovir and foscarnet.

Toxoplasmosis Retinochoroiditis

Ocular toxoplasmosis affects less than 1% of HIV-infected patients in most countries (see Table 2).197–201,254–256 Toxoplasmosis retinochoroiditis in HIV-positive patients is usually distinguished by the occurrence of a moderate to severe anterior chamber and vitreous inflammation, a relative lack of retinal hemorrhage, and the presence of a smooth rather than granular leading edge (Fig. 12D). Moreover, unlike toxoplasmosis retinochoroiditis in immunocompetent patients, HIV-infected patients often have multifocal and bilateral disease, with no evidence of inactive toxoplasmosis scars. Testing should include serology for IgG and IgM toxoplasmosis antibodies, but may be negative in profoundly immunosuppressed patients. Between 30% and 50% of HIV-positive patients with toxoplasmosis retinochoroiditis will have central nervous system involvement.199,200 Treatment consists of pyrimethamine in combination with a sulfonamide or clindamycin, either alone or in combination. Chronic or repeated therapy is often necessary. Atovaquone has been used successfully in the treatment of toxoplasmosis retinochoroiditis in an HIV-positive patient,257 but it is expensive and has yet to be shown to be superior to more standard combination therapy.

Bacterial and Fungal Retinitis

Ocular syphilis is the most common intraocular bacterial infection in HIV-positive patients, affecting up to 2% of patients (see Table 2). Patients may present with either an iridocyclitis214,215 or a more diffuse intraocular inflammation, with or without retinal or optic nerve involvement.202–217 Laboratory testing should include both a rapid plasma reagin (RPR) or Venereal Diseases Research Laboratory (VDRL) test and a specific treponemal antibody (fluorescent treponemal antibody absorption [FTA-ABS] or micro-hemagglutination treponemal pallidum [MHA-TP]) test. Rarely, these test may be negative in HIV-positive patients despite active intraocular disease.217 Treatment includes intravenous penicillin G, 24 million units/day for 7 to 10 days. Recurrences can occur even after adequate treatment.

Other bacterial and fungal causes of retinitis or endophthalmitis are rare in HIV-infected patients,218–225,253,257 but have included Staphylococcus aureus,223,225 Histoplasma capsulatum,218 Sporothrix schenckii,219 Bipolaris hawaiienisis,222 and Fusarium.224 Neuroretinitis associated with systemic Bartonella henselae infection has also been described in these patients.258,259

INFECTIOUS CHOROIDITIS

Infectious choroiditis is uncommon in HIV-infected patients, accounting for less than 1% of all eye findings in most clinic-based series (see Table 2).27,260–264 Organisms have included Pneumocystis carinii (Fig. 13), Cryptococcus neoformans, M. avium complex, Mycobacterium tuberculosis, H. capsulatum, Candida, and Aspergillus fumigatus. Most of these cases have appeared in autopsy series, reflecting the serious nature of the underlying systemic infections. Up to one third of cases have concurrent CMV retinitis.27,264

Fig. 13. Acute (A) and healed (B) Pneumocystis carinii choroiditis in a patient with AIDS.

INTRAOCULAR LYMPHOMA

HIV-infected patients are at increased risk for developing non-Hodgkin's lymphoma.139 Although uncommon, cases of intraocular lymphoma have been reported in HIV-infected patients, and are composed primarily of B cells.265–267 Treatment includes radiation and chemotherapy.

RETINAL VEIN OR ARTERY OCCLUSION

Large retinal vessel occlusion occurs in less than 1% of patients with AIDS and appears to be more common in severely immunosuppressed persons.30,33 Retinal veins are affected more often than retinal arteries.33 The cause is unknown but might be related to the same rheologic and vascular factors that contribute to small retinal vessel disease.149

Back to Top
ORBITAL MANIFESTATIONS OF HIV INFECTION
Orbital complications, most commonly orbital lymphoma17,33,65,268–273 or orbital cellulitis,254,274–281 occur in well under 1% of HIV-infected patients (see Table 2; Table 6). Causative organisms have included Aspergillus,274–276,280 Propionibacterium acnes,274 Pseudomonas aeruginosa,274,278,279 Staphylococcus aureus,274 Treponema pallidum,274 Rhizopus arrhizus,281 Toxoplasma gondii,254 and Pneumocystis carinii.274,279 Concurrent infection of the sinuses appears common.272,280 Isolated reports of orbital Kaposi's sarcoma,10 inflammatory pseudotumor,282 myositis,283 eosinophilic granuloma,284 and metastatic carcinoma285 have been described. Lymphoma and Kaposi's sarcoma are treated with radiation and chemotherapy. Treatment of orbital cellulitis includes systemic antibiotics and, as needed, surgical débridement.

 

TABLE 6. Orbital and Neuro-ophthalmic Manifestations of HIV Infection


OrbitalNeuro-ophthalmic
Orbital lymphomaPapilledema
Orbital cellulitisOptic neuritis
Orbital Kaposi's sarcomaOptic atrophy
 Cranial nerve palsies
 Ocular Motility disorders
 Visual field defects

 

Back to Top
NEURO-OPHTHALMIC MANIFESTATIONS OF HIV INFECTION
Neuro-ophthalmic manifestations occur in 10% to 15% of HIV-infected patients (see Table 2).33,44,45,83 Most common findings include optic nerve head edema (Fig. 14) related to either papilledema or direct optic neuritis; nonspecific optic atrophy; cranial nerve palsies, especially of the sixth nerve; oculomotor abnormalities, such as nystagmus, gaze palsies, internuclear ophthalmoparesis, and skew deviation; and visual field defects. Virtually any infectious or neoplastic process can produce these changes, but meningeal and parenchymal lymphoma, Cryptococcus infection, neurosyphilis, and toxoplasmosis are most frequent. More diffuse encephalopathies related either to direct HIV effects (HIV encephalopathy) or to secondary infection with the polyomavirus JC (progressive multifocal leukoencephalopathy)286 may cause similar complications. In most instances, evaluation includes magnetic resonance imaging, followed by a lumbar puncture for cell count, cytology, culture, and antibody and antigen testing. Treatment includes radiation and chemotherapy in the case of lymphoma, and specific antibiotic therapy for identified infectious causes. There is currently no treatment for HIV encephalopathy or progressive multifocal leukoencephalopathy.

Fig. 14. Optic disc edema with surrounding cotton-wool spots and intraretinal hemorrhages due to neurosyphilis (A) and cryptococcal meningitis with papilledema (B) in two different patients with AIDS.

Back to Top
OCULAR MANIFESTATION OF HIV INFECTION IN CHILDREN
Children appear to have fewer ocular manifestations of HIV infection and an especially low incidence of CMV retinitis.18,28,287–289 The reason for this difference is unknown, but may relate to an altered immune response to HIV or a lower prevalence of CMV seropositivity in children. HIV-infected children are, however, at increased risk for neurodevelopmental delay,290,291 a condition often associated with neuro-ophthalmic complications. A fetal AIDS-associated embryopathy, with downward obliquity of the eyes, prominent palpebral fissures, hypertelorism, and blue sclerae, has also been described.292,293
Back to Top
OCULAR MANIFESTATION OF HIV INFECTION IN THE DEVELOPING WORLD
The majority of HIV-infected persons live in the developing world, particularly in sub-Saharan Africa and Southeast Asia.1,2 Studies of the ocular complications of HIV infection in these parts of the world are only beginning to appear, but suggest that CMV retinitis is less frequent than observed in developed countries, and that otherwise rare ocular opportunistic infections, such as toxoplasmosis and tuberculosis, affect 2% to 10% of patients with AIDS.13,21,24–26,29,32,41 The reasons for such an altered spectrum of ocular disease in developing countries are almost assuredly related both to poorer medical care and consequent patient death at a higher CD4+ T-lymphocyte level, and to a higher rate of endemic exposure to toxoplasmosis and tuberculosis.
Back to Top
DRUG-RELATED OCULAR TOXICITY IN HIV-INFECTED PATIENTS
As mentioned, rifabutin230–232 has been associated with uveitis and cidofovir233,234 with both uveitis and intraocular hypotony in HIV-positive patients receiving these medicines. Retinal pigment epithelium mottling and hypertrophy accompanied by overall decreased retinal function has also been described with the use of high-dose didanosine.294,295 In addition, a syndrome of corneal epithelial inclusions, termed “corneal lipidosis,” has been associated with the use of ganciclovir and acyclovir.296 Lastly, long-term atovaquone can cause vortex keratopathy.297 These effects all appear to be doserelated and, with the exception of retinal pigment epithelial scarring, tend to resolve once the drug is discontinued.
Back to Top
REFERENCES

1. WHO Global AIDS Statistics: AIDS cases reported to the World Health Organization as of 7 July 1995. Aids Care 7:689, 1995

2. AIDS rates. MMWR 45:926, 1996

3. 1993 Revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR 41(RR-17):1, 1992

4. Fauci AS, Pantaleo G, Stanley S, Weissman D: Immunopathogenic mechanisms of HIV infection. Ann Intern Med 124:654, 1996

5. Turner BJ, Hecht FM, Ismail RB: CD4+ T-lymphocyte measures in the treatment of individuals infected with human immunodeficiency virus type 1. Arch Intern Med 154:1561, 1994

6. Holland GN, Gotlieb MS, Yee RD et al: Ocular disorders associated with a new severe acquired cellular immunodeficiency syndrome. Am J Ophthalmol 93:393, 1982

7. Holland GN, Pepose JS, Pettit TH et al: Acquired immune deficiency syndrome: ocular manifestations. Ophthalmology 90:859, 1983

8. Rosenberg PR, Uliss AE, Friedland GH et al: Acquired immunodeficiency syndrome: ophthalmic manifestations in ambulatory patients. Ophthalmology 90:874, 1983

9. Palestine AG, Rodrigues MM, Macher AM et al: Ophthalmic involvement in acquired immunodeficiency syndrome. Ophthalmology 91:1092, 1984

10. Freeman WR, Lerner CW, Mines JA et al: A prospective study of the ophthalmologic findings in the acquired immune deficiency syndrome. Am J Ophthalmol 97:133, 1984

11. Khadem M, Kalish SB, Goldsmith J et al: Ophthalmologic findings in acquired immune deficiency syndrome (AIDS). Arch Ophthalmol 102:201, 1984

12. Pepose JS, Holland GN, Nestor MS et al: Acquired immune deficiency syndrome: pathogenic mechanisms of ocular disease. Ophthalmology 92:472, 1985

13. Kestelyn P, Van de Perre P, Rouvroy D et al: A prospective study of the ophthalmologic findings in the acquired immune deficiency syndrome in Africa. Am J Ophthalmol 100:230, 1985

14. Mines JA, Kaplan HJ: Acquired immunodeficiency syndrome (AIDS): the disease and its ocular manifestations. Int Ophthalmol Clin 26:73, 1986

15. Humphry RC, Weber JN, Marsh RJ: Ophthalmic findings in a group of ambulatory patients infected by human immunodeficiency virus (HIV): A prospective study. Br J Ophthalmol 71:565, 1987

16. Fabricius EM, Jager H, Prantl F et al: AIDS of the eye: a retrospective analysis of 70 HIV-infected patients. Fortschr Ophthalmol 85:420, 1988

17. Jabs DA, Green WR, Fox R et al: Ocular manifestations of acquired immune deficiency syndrome. Ophthalmology 96:1092, 1989

18. Dennehy PJ, Warman R, Flynn JT et al: Ocular manifestations in pediatric patients with acquired immunodeficiency syndrome. Arch Ophthalmol 107:978, 1989

19. Jensen OA, Klinken L: Pathology of brain and eye in the acquired immune deficiency syndrome (AIDS). APMIS 97:196, 1989

20. Fabricius EM, Prantl F, Jager H et al: Incidence and pathogenesis of ocular symptoms in HIV infection. Fortschr Ophthalmol 86:461, 1989

21. Auzemery A, Queguiner P, Georges AJ et al: Ophthalmologic manifestations of acquired immunodeficiency syndrome (AIDS) in central Africa. Med Trop (Mars) 50:441, 1990

22. II'nitskii VA, Manuilov NN, Meleshenkova TI: Eye manifestations of AIDS in the population of the Republic of Burundi. Vestn Oftalmol 106:58, 1990

23. Gabrieli CB, Angarano G, Moramarco A et al: Ocular manifestations in HIV-seropositive patients. Ann Ophthalmol 22:173, 1990

24. Kawe LW, Renard G, Le Hoang P et al: Ophthalmologic manifestations of AIDS in an African milieu: report of 45 cases. J Fr Ophtalmol 13:199, 1990

25. Ho PCP, Farzavandi SK, Kwok SK et al: Ophthalmic complications of AIDS in Hong Kong. J Hong Kong Med Assoc 46:118, 1994

26. el Matri L, Kammoun M, Cheour M et al: Eye involvement in AIDS: the first 12 Tunisian cases. Tunis Med 70:481, 1992

27. Morinelli EN, Dugel PU, Riffenburgh R, Rao NA: Infectious multifocal choroiditis in patients with acquired immune deficiency syndrome. Ophthalmology 100:1014, 1993

28. Iordanescu C, Matusa R, Denislam D et al: The ocular manifestations of AIDS in children. Oftalmologia 37:308, 1993

29. Ndoye NB, Sow PS, Ba EA et al: Ocular manifestations of AIDS in Dakar. Dakar Med 38:97, 1993

30. Muccioli C, Belfort R Jr, Lottenberg C et al: Achados oftalmologicos em AIDS: avaliacao de 445 casos atendidos em um ano. Rev Assoc Med Bras 40:155, 1994

31. Seregard S: Retinochoroiditis in the acquired immune deficiency syndrome: findings in consecutive post-mortem examinations. Acta Ophthalmol 72:223, 1994

32. Lewallen S, Kumwenda J, Maher D, Harries AD: Retinal findings in Malawian patients with AIDS. Br J Ophthalmol 78:757, 1994

33. Jabs DA: Ocular manifestations of HIV infection. Trans Am Ophthalmol Soc 93:623, 1995

34. Maclean H, Hall AJH, McCombe MF, Sandland AM: AIDS and the eye: a 10-year experience. Austr NZ J Ophthalmol 24:61, 1996

35. Meisler DM, Lowder CY, Holland GN: Corneal and external ocular infections in acquired immunodeficiency syndrome (AIDS). In Krachmer JH, Mannis MJ, Holland EJ (eds): Cornea: Cornea and External Disease: Clinical Diagnosis and Management, Vol 2, Chap 86, pp 1017-22. St. Louis, Mosby, 1997

36. Jabs DA: Acquired immunodeficiency syndrome and the eye—1996. Arch Ophthalmol 114:863, 1996

37. Jabs DA, Quinn TC: Acquired immunodeficiency syndrome. In Pepose JS, Holland GN, Wilhelmus KR (eds): Ocular Infection & Immunity, Chap 22, pp 289–310. St. Louis, Mosby, 1996

38. Tay-Kearney ML, Jabs DA: Ophthalmic complications of HIV infection. Med Clin North Am 80:1471, 1996

39. Nussenblatt RB, Whitcup SM, Palestine AG: Acquired immunodeficiency syndrome. In Uveitis, Fundamentals and Clinical Practice, 2nd ed, Chap 1, pp 186-97. St. Louis, Mosby, 1996

40. Sarraf D, Ernest JT: AIDS and the eyes. Lancet 348:525, 1996

41. Courtright P: The challenge of HIV/AIDS related eye disease. Br J Ophthalmol 80:496, 1996

42. Eller AW, Warren BB, Conti ER, Rubin TM: AIDS and the eye. Pennsylvania Med 99(suppl): 88, 1996

43. Chronister CL: Review of external ocular disease associated with AIDS and HIV infection. Optom Vis Sci 73:225, 1996

44. Currie J: AIDS and neuro-ophthalmology. Curr Opin Ophthalmol 6:34, 1995

45. Miller NR: Viruses and viral diseases. In: Walsh and Hoyt's Clinical Neuro-Ophthalmology, 4th ed, Vol 5, Pt 2, Chap 71, pp 4107–4156. Baltimore, Williams & Wilkins, 1995

46. Akduman L, Pepose JS: Anterior segment manifestations of acquired immunodeficiency syndrome. Semin Ophthalmol 10:111, 1995

47. Kuppermann BD: Noncytomegalovirus-related chorio-retinal manifestations of the acquired immunodeficiency syndrome. Semin Ophthalmol 10:125, 1995

48. Rajeev B, Rao NA: Ocular pathological changes in acquired immunodeficiency syndrome. Semin Ophthalmol 10:168, 1995

49. Luckie A, Ai E: Pitfalls and unusual manifestations of acquired immunodeficiency syndrome in the retina. Semin Ophthalmol 10:155, 1995

50. Rickman LS, Freeman WR: Medical and virological aspects of ocular human immunodeficiency virus infection for the ophthalmologist. Semin Ophthalmol 10:91, 1995

51. Park KL, Smith RE, Rao NA: Ocular manifestations of AIDS. Curr Opin Ophthalmol 6:82, 1995

52. McCluskey PJ, Hall AJ, Lightman S: HIV and eye disease. Med J Austr 164:484, 1995

53. Harrison TJ: Ocular complication in HIV infected individuals. Alaska Med 37:91, 1995

54. McCluskey PJ, Wakefield D: Posterior uveitis in the acquired immunodeficiency syndrome. Int Ophthalmol Clin 35:1, 1995

55. Bernauer W: The eye and HIV. Schweiz Rundsch Med Prax 84:1403, 1995

56. Armstrong RA: Acquired immunodeficiency syndrome (AIDS) and the eye. Ophthalmic Physiol Optics 15(suppl 2):S42, 1995

57. Litwak AB: Non-CMV infectious chorioretinopathies in AIDS. Optom Vis Sci 72:312, 1995

58. McMullen WW, D'Amico DJ: AIDS and its ophthalmic manifestations. In Albert DM, Jakobiec FA (eds): Principles and Practice of Ophthalmology: Clinical Practice, Vol 5, Chap 251, pp 3102–3119. Philadelphia, WB Saunders, 1994

59. Rao NA: Acquired immunodeficiency syndrome and its ocular complications. Ind J Ophthalmol 42:51, 1994

60. Rickman LS, Freeman WR: Retinal disease in the HIV infected patient. In Ryan SJ (ed): Retina, 2nd ed, Vol 2, Medical Retina, Chap 96, pp 1571–1596. St. Louis, Mosby, 1994

61. Holland GN: AIDS: Retinal and choroidal infections. In Lewis H (ed): Medical and Surgical Retina, Chap 35, pp 415–433. St. Louis, Mosby-Year Book, 1994

62. Schnaudigel OE, Gumbel H, Richter R et al: Ophthalmologic manifestations in early and late stages of AIDS. Ophthalmologe 91:668, 1994

63. Glavici M: The ocular manifestations in AIDS. Oftalmologia 38:216, 1994

64. Freeman WR: Retinal disease associated with AIDS. Austr NZ J Ophthalmol 21:71, 1993

65. Mansour AM: Adnexal findings in AIDS. Ophthalmic Plast Reconstr Surg 9:273, 1993

66. Gariano RF, Rickman LS, Freeman WR: Ocular examination and diagnosis in patients with the acquired immunodeficiency syndrome. West J Med 158:254, 1993

67. McCluskey PH: HIV-related eye disease. Med J Austr 158:111, 1993

68. Cernak A, Filova I, Pont'uchova E et al: AIDS and the eye. Cesk Oftalmol 49:387, 1993

69. Banuelos Banuelos J, Gonzalez Ortiz MA, Sayagues Gomez O, Barros Aguado C: Ocular complications in AIDS patients. Rev Clin Esp 193:393, 1993

70. Nagata Y, Fujino Y, Mochizuki M: Ophthalmic manifestations in AIDS. Nippon Rinsho 51(suppl):413, 1993

71. Garweg J: Opportunistic eye diseases within the scope of HIV infection. Klin Monatsbl Augenheilkd 202:465, 1993

72. Bonnet S, Marechal G: Ophthalmological involvement in AIDS. Rev Med Liege 48:91, 1993

73. Dunn JP, Holland GN: Human immunodeficiency virus and opportunistic ocular infections. Infect Dis Clin North Am 6:909, 1992

74. Holland GN: Medical treatment of retinal infections in patients with AIDS. West J Med 157:448, 1992

75. Holland GN: Acquired immunodeficiency syndrome and ophthalmology: the first decade. Am J Ophthalmol 114:86, 1992

76. Frangieh GT, Dugel PU, Rao NA: Ocular manifestations of acquired immunodeficiency syndrome. Curr Opin Ophthalmol 3:228, 1992

77. Heinemann MH: Medical management of AIDS patients: ophthalmic problems. Med Clin North Am 76:83, 1992

78. Blumenkranz MS, Penneys NS: Acquired immunodeficiency syndrome and the eye. Dermatol Clin 10:777, 1992

79. Siwicka R: Ocular manifestations in AIDS. Klin Oczna 94:309, 1992

80. Ugen KE, McCallus DE, Von Feldt JM et al: Ocular tissue involvement in HIV infection: immunological and pathological aspects. Immunol Res 11:141, 1992

81. Morinelli EN, Dugel PU, Lee M et al: Opportunistic intraocular infections in AIDS. Trans Am Ophthalmol Soc 90:97, 1992

82. de Smet MD, Nussenblatt RB: Ocular manifestations of AIDS. JAMA 266:3019, 1991

83. Keane JR: Neuro-ophthalmologic signs of AIDS. Neurology 41:841, 1991

84. Friedman DI: Neuro-ophthalmic manifestations of human immunodeficiency virus infection. Neurol Clin 9:55, 1991

85. Martenet AC: Unusual ocular lesions in AIDS. Int Ophthalmol 14:359, 1990

86. Bernauer W, Daicker B: HIV patient and eyes. J Suisse Med 120:888, 1990

87. Kestelyn P: Ocular problems in AIDS. Int Ophthalmol 14:165, 1990

88. Lund OE, Klauss V, Scheiffarth OF: AIDS and the eye. Fortschr Ophthalmol 87(suppl):S94, 1990

89. Holtmann HW: AIDS and ophthalmology. Z Arztl Fortbild (Jena) 84:919, 1990

90. Marsh RJ: Ocular manifestations of AIDS. Br J Hosp Med 42:224, 1989

91. Shuler JD, Engstrom RE, Holland GN: External ocular disease and anterior segment disorders associated with AIDS. Int Ophthalmol Clin 29:98, 1989

92. Culbertson WW: Infections of the retina in AIDS. Int Ophthalmol Clin 29:108, 1989

93. O'Donnell JJ, Jacobson MA: Cotton-wool spots and cytomegalovirus retinitis in AIDS. Int Ophthalmol Clin 29:105, 1989

94. Boguszakova J, Stankova M: Eye disorders in AIDS. Cesk Oftalmol 45:380, 1989

95. Newsome DA: Noninfectious ocular complications of AIDS. Int Ophthalmol Clin 29:95, 1989

96. Vedy J, Queguiner P, Auzemery A et al: Ophthalmologic manifestations of AIDS in Africa. Rev Int Trach Pathol Ocul Trop Subtrop Sante Publique 65:107, 1988

97. Katlama C: The eye and AIDS. Ophthalmologie 3(suppl 1):5, 1989

98. Ai E, Wong KL: Ophthalmic manifestations of AIDS. Ophthalmol Clin North Am 1:53, 1988

99. Klauss V, Lund OE: Eye changes in AIDS. Fortschr Med 106:393, 1988

100. Garavelli PL, Astori MR: Ocular pathology in AIDS and related syndromes. Minerva Med 79:295, 1988

101. Zhaboedov GD, Bondareva GS: Eye manifestations of AIDS. Vestn Oftalmol 104:65, 1988

102. Petroni-Placente M, Rossazza C, Tacheix V, Le Calve M: Ophthalmological symptoms of AIDS. Bull Soc Ophtalmol France 88:123, 1988

103. Kreiger AE, Holland GN: Ocular involvement in AIDS. Eye 2 (Pt 5):496, 1988

104. Maichuk IuF: AIDS: clinical aspects of eye lesions. Oftalmologicheskii Zh 4:240, 1988

105. Fabricius EM, Jager H, Lander T et al: Eye involvement in AIDS. Klin Monatsbl Augenheilkd 191:95, 1987

106. Dhermy P: AIDS in ophthalmology. Ann Ther Clin Ophthalmol 38:255, 1987

107. Fujikawa LS, Palestine AG, Schwartz LK, Nussenblatt RB: Ocular involvement in the acquired immunodeficiency syndrome. In Tasman W, Jaeger EA (eds): Duane's Clinical Ophthalmology, Vol 2, Chap 36, pp 1–9, 1986

108. Hansen LL, Wiecha I, Witschel H: Initial diagnosis of acquired immunologic deficiency syndrome (AIDS) by the ophthalmologist. Klin Monatsbl Augenheilkd 191:133, 1987

109. Humphry RC, Parkin JM, Marsh RJ: The ophthalmological features of AIDS and AIDS related disorders. Trans Ophthalmol Soc UK 105:505, 1986

110. Grasl M, Radda T, Hutterer J: AIDS and the eye. Klin Monatsbl Augenheilkd 187:457, 1985

111. Sonnerborg A, Julander I: AIDS and AIDS-related diseases: clinical manifestations and therapy. Lakartidningen 82:1877, 1985

112. Bass SJ: Ocular manifestations of AIDS. J Am Optometric Assoc 55:765, 1984

113. Le Hoang P, Piette JC, Rozembaum W et al: Ophthalmoscopic manifestations observed in AIDS. Bull Soc Ophtalmol France 84:377, 1984

114. Schuman JS, Friedman AH: Retinal manifestations of the acquired immune deficiency syndrome (AIDS): cytomegalovirus, Candida albicans, Cryptococcus, toxoplasmosis, and Pneumocystis carinii. Trans Ophthalmol Soc UK 103:177, 1983

115. Karbassi M, Raizman MB, Schuman JS: Herpes zoster ophthalmicus. Surv Ophthalmol 36:395, 1992

116. Cole EL, Meisler DM, Calabrese LH et al: Herpes zoster ophthalmicus and acquired immune deficiency syndrome. Arch Ophthalmol 102:1027, 1984

117. Sandor EV, Millman A, Croxson TS et al: Herpes zoster ophthalmicus in patients at risk for AIDS. Am J Ophthalmol 101:153, 1986

118. Tschachler E, Bergstresser PR, Stingl G: HIV-related skin diseases. Lancet 348:659, 1996

119. Macher AM, Palestine A, Masur H et al: Multicentric Kaposi's sarcoma of the conjunctiva in a male homosexual with the acquired immune deficiency syndrome. Ophthalmology 90:859, 1983

120. Shuler JD, Holland GN, Miles SA et al: Kaposi sarcoma of the conjunctiva and eyelids associated with the acquired immunodeficiency syndrome. Arch Ophthalmol 107:858, 1989

121. Dugel PU, Gill PS, Frangieh GT, Rao NA: Ocular adnexal Kaposi's sarcoma in acquired immunodeficiency syndrome. Am J Ophthalmol 110:500, 1990

122. Dugel PU, Gill PS, Frangieh GT, Rao NA: Treatment of ocular adnexal Kaposi's sarcoma in acquired immune deficiency syndrome. Ophthalmology 99:1127, 1992

123. Ghabrial R, Quivey JM, Dunn JP Jr, Char DH: Radiation therapy of acquired immunodeficiency syndrome-related Kaposi's sarcoma of the eyelids and conjunctiva. Arch Ophthalmol 110:1423, 1992

124. Hummer J, Gass JD, Huanga JW: Conjunctival Kaposi's sarcoma treated with interferon α-2a. Am J Ophthalmol 116:502, 1993

125. Offermann MK: HHV-8: a new herpesvirus associated with Kaposi's sarcoma. Trends Microbiol 4:383, 1996

126. Kohn SR: Molluscum contagiosum in patients with acquired immunodeficiency syndrome. Arch Ophthalmol 105:458, 1987

127. Charles NC, Friedberg DN: Epibulbar molluscum contagiosum in acquired immune deficiency syndrome: case report and review of the literature. Ophthalmology 99:1123, 1992

128. Robinson MR, Udell IJ, Garber PF et al: Molluscum contagiosum of the eyelids in patients with acquired immunodeficiency syndrome. Ophthalmology 99:1745, 1992

129. Bardenstein DS, Elmets C: Hyperfocal cryotherapy of multiple molluscum contagiosum lesions in patients with the acquired immune deficiency syndrome. Ophthalmology 102:1031, 1995

130. Winward KE, Curtin VT: Conjunctival squamous cell carcinoma in a patient with human immunodeficiency virus infection. Am J Ophthalmol 107:554, 1989

131. Kim RY, Seiff SR, Howes EL, O'Donnell JJ: Necrotizing scleritis secondary to conjunctival squamous cell carcinoma in acquired immunodeficiency syndrome. Am J Ophthalmol 109:231, 1990

132. Kestelyn PH, Stevens AM, Ndayambaje A et al: HIV and conjunctival malignancies. Lancet 336:51, 1990

133. Ateenyl-Agaba C: Conjunctival squamous-cell carcinoma associated with HIV infection in Kampala, Uganda. Lancet 345:695, 1995

134. Karp CL, Scott IU, Chang TS, Pflugfelder SC: Conjunctival intraepithelial neoplasia: a possible marker for human immunodeficiency virus infection? Arch Ophthalmol 114:257, 1996

135. Muccioli C, Belfort R, Burnier M, Rao N: Squamous cell carcinoma of the conjunctiva in a patient with the acquired immune deficiency syndrome. Am J Ophthalmol 121:94, 1996

136. McQueen H, Dhillon B, Ironside J: Squamous cell carcinoma of the eyelid and the acquired immune deficiency syndrome. Am J Ophthalmol 114:219, 1996

137. Lewalen S, Shroyer KR, Keyser RB, Liomba G: Aggressive conjunctival squamous cell carcinoma in three young Africans. Arch Ophthalmol 114:215, 1996

138. Margo CE, Mack W, Guffey JM: Squamous cell carcinoma of the conjunctiva and human immune deficiency virus infection. Arch Ophthalmol 114:349, 1996

139. Sandler AS, Kaplan L: AIDS lymphoma. Curr Opin Oncol 8:377, 1996

140. Goldberg SH, Fieo AG, Wolz DE: Primary eyelid non-Hodgkin's lymphoma in a patient with acquired immunodeficiency syndrome. Am J Ophthalmol 113:216, 1992

141. Janier M, Schwartz C, Dontenwille MN, Civatte J: Hypertrichose des cils au cours du SIDA. Ann Dermatol Venereol 11:1490, 1987

142. Casanova JM, Puig T, Rubio M: Hypertrichosis of the eyelashes in acquired immunodeficiency syndrome. Arch Dermatol 123:1599, 1987

143. Roger D, Vaillant L, Arbeille-Brassart B et al: Quelle est la cause de l'hypertrichose ciliaire acquise du SIDA? Ann Dermatol Venereol 115:1055, 1988

144. Lopez Dupla JM, Valencia ME, Pintado V, Khamashta MA: Tricomegalia: una excepcional expression del sindrome de immunodeficiencia adquirida. Med Clin 92:556, 1989

145. Klutman NE, Hinthorn DR: Excessive growth of eyelashes in a patient with AIDS being treated with zidovudine. N Engl J Med 324:1896, 1991

146. Kaplan MH, Sadick NS, Talmor M: Acquired trichomegaly of the eyelashes: a cutaneous marker of acquired immunodeficiency syndrome. J Am Acad Dermatol 25:801, 1991

147. Sahai J, Conway B, Cameron D, Gaber G: Zidovudine-associated hypertrichosis and nail pigmentation in an HIV-infected patient. AIDS 5:1395, 1991

148. Teich SA: Conjunctival microvascular changes in AIDS and AIDS-related complex. Am J Ophthalmol 103:332, 1987

149. Engstrom RE, Holland GN, Hardy WD et al: Hemorrheologic abnormalities in patients with human immunodeficiency virus infection and ophthalmic microvasculopathy. Am J Ophthalmol 109:153, 1990

150. Brown HH, Glasgow BJ, Holland GN, Foos RY: Cytomegalovirus infection of the conjunctiva in AIDS. Am J Ophthalmol 106:102, 1988

151. Espana-Gregori E, Vera-Sempere FJ, Cano-Parra J et al: Cytomegalovirus infection of the caruncle in the acquired immunodeficiency syndrome. Am J Ophthalmol 117:406, 1994

152. Balmes R, Bialasiewicz AA, Busse H: Conjunctival cryptococcosis preceding human immunodeficiency virus seroconversion. Am J Ophthalmol 113:719, 1992

153. Gordon JJ, Golbus J, Kurtides ES: Chronic lymphadenopathy and Sjögren's syndrome in a homosexual man. N Engl J Med 311:1441, 1984

154. Couderc LJ, D'Agay MF, Danon F et al: Sicca complex and infection with human immunodeficiency virus. Arch Intern Med 147:898, 1987

155. Pflugfelder SC, Savlsow R, Ullman S: Peripheral corneal ulceration in a patient with AIDS-related complex. Am J Ophthalmol 104:542, 1987

156. Lucca JA, Farris RL, Bielory L, Caputo AR: Keratoconjunctivitis sicca in male patients infected with human immunodeficiency virus type 1. Ophthalmology 97:1008, 1990

157. Lucca JA, Kung JS, Farris RL: Keratoconjunctivitis sicca in female patients infected with human immunodeficiency virus. CLAO J 20:49, 1994

158. Engstrom RE, Holland GN: Chronic herpes zoster virus keratitis associated with the acquired immunodeficiency syndrome. Am J Ophthalmol 105:556, 1988

159. Silverstein BE, Chandler D, Neger R, Margolis TP: Disciform keratitis: a case of herpes zoster sine herpete. Am J Ophthalmol 123:254, 1997

160. Young TL, Robin JB, Holland GN et al: Herpes simplex keratitis in patients with acquired immune deficiency syndrome. Ophthalmology 96:1476, 1989

161. McLeish W, Pfulugfelder SC, Course C et al: Interferon treatment of herpetic keratitis in a patient with acquired immunodeficiency syndrome. Am J Ophthalmol 109:93, 1990

162. Rosenwasser GOD, Greene WH: Simultaneous herpes simplex types 1 and 2 keratitis in acquired immunodeficiency syndrome. Am J Ophthalmol 113:102, 1992

163. Hodge WG, Margolis TP: Herpes simplex virus keratitis among patients who are positive or negative for human immunodeficiency virus: an epidemiologic study. Ophthalmology 104:120, 1997

164. Wilhelmus KR, Font RL, Lehmann RP, Cernoch PL: Cytomegalovirus keratitis in acquired immunodeficiency syndrome. Arch Ophthalmol 114:869, 1996

165. Ticho BH, Urban RC Jr, Safran MJ, Saggau DD: Capnocytophaga keratitis associated with poor dentition and human immunodeficiency virus infection. Am J Ophthalmol 109:352, 1990

166. Nanda M, Pflugfelder SC, Holland S: Fulminant pseudomonal keratitis and scleritis in human immunodeficiency virus-infected patients. Arch Ophthalmol 109:503, 1991

167. Maguen E, Salz JJ, Nesburn AB: Pseudomonas corneal ulcer associated with rigid, gas-permeable, daily-wear lenses in a patient infected with human immunodeficiency virus. Am J Ophthalmol 113:336, 1992

168. Hemady RK, Griffin N, Aristimuno B: Recurrent corneal infections in a patient with the acquired immunodeficiency syndrome. Cornea 12:266, 1993

169. Aristimuno B, Nirankari VS, Hemady RK, Rodrigues MM: Spontaneous ulcerative keratitis in immunocompromised patients. Am J Ophthalmol 115:202, 1993

170. Santos C, Parker J, Dawson C, Ostler B: Bilateral fungal corneal ulcers in a patient with AIDS-related complex. Am J Ophthalmol 102:118, 1986

171. Parrish CM, O'Day DM, Hoyle TC: Spontaneous fungal corneal ulcer as an ocular manifestation of AIDS. Am J Ophthalmol 104:302, 1987

172. Bryan RT: Microsporidiosis as an AIDS-related opportunistic infection. Clin Infect Dis 21(suppl 1):562, 1995

173. Lowder CY, Meisler DM, McMahon JT et al: Microsporidia infection of the cornea in a man seropositive for human immunodeficiency virus. Am J Ophthalmol 109:242, 1990

174. Cali A, Meisler DM, Rutherford I et al: Corneal microsporidiosis in a patient with AIDS. Am J Trop Med Hygiene 44:463, 1991

175. Cali A, Meisler DM, Lowder CY et al: Corneal microsporidiosis: characterization and identification. J Protozool 38:215S, 1991

176. Davis RM, Font RL, Keisler MS, Shadduck JA: Corneal microsporidiosis: a case report including ultrastructural observations. Ophthalmology 97:953, 1990

177. Friedberg DN, Stenson SM, Orenstein JM et al: Microsporidial keratoconjunctivitis in acquired immunodeficiency syndrome. Arch Ophthalmol 108:504, 1990

178. Didier ES, Didier PJ, Friedberg DN et al: Isolation and characterization of a new human microsporidian, Encephalitozoon hellem (n. sp.), from three AIDS patients with keratoconjunctivitis. J Infect Dis 163:617, 1991

179. Yee RW, Tio FO, Martinez JA et al: Resolution of microsporidial epithelial keratopathy in a patient with AIDS. Ophthalmology 98:196, 1991

180. Metcalfe TW, Doran RM, Rowlands PL et al: Microsporidial keratoconjunctivitis in a patient with AIDS. Br J Ophthalmol 76:177, 1992

181. Diesenhouse MC, Wilson LA, Corrent GF et al: Treatment of microsporidial keratoconjunctivitis with topical fumagillin. Am J Ophthalmol 115:293, 1993

182. McCluskey PJ, Goonan PV, Marriott DJ, Field AS: Microsporidial keratoconjunctivitis in AIDS. Eye 7:80, 1993

183. Schwartz DA, Visvesvara GS, Diesenhouse MC et al: Pathologic features and immunofluorescent antibody demonstration of ocular microsporidiosis (Encephalitozoon hellem) in seven patients with acquired immunodeficiency syndrome. Am J Ophthalmol 115:285, 1993

184. Rosberger DF, Serdarevic ON, Erlandson RA et al: Successful treatment of microsporidial keratoconjunctivitis with topical fumagillin in a patient with AIDS. Cornea 12:261, 1993

185. Lowder CY: Ocular microsporidiosis. Int Ophthalmol Clin 33:145, 1993

186. Gunnarsson G, Hurlbut D, DeGirolami PC et al: Multiorgan microsporidiosis: Report of five cases and review. Clin Infect Dis 21:37, 1995

187. Lowder CY, McMahon JT, Meisler DM et al: Microsporidial keratoconjunctivitis caused by Septata intestinalis in a patient with acquired immunodeficiency syndrome. Am J Ophthalmol 121:715, 1996

188. Shah GK, Pfister D, Probst LE et al: Diagnosis of microsporidial keratitis by confocal microscopy and the chromotrope stain. Am J Ophthalmol 121:89, 1996

189. Holland GN, Tufail A, Jordan MC: Cytomegalovirus disease. In Pepose JS, Holland GN, Wilhelmus KR (eds): Ocular Infection and Immunity, Chap 81, pp 1088–1120. St. Louis, Mosby, 1996

190. Dunn JP, Jabs DA: Cytomegalovirus retinitis in AIDS: natural history, diagnosis, and treatment. AIDS Clin Rev 99, 1995-1996

191. Foster DJ, Dugel PU, Frangieh GT et al: Rapidly progressive outer retinal necrosis in the acquired immunodeficiency syndrome. Am J Ophthalmol 110:341, 1990

192. Margolis TP, Lowder CY, Holland GN et al: Varicella-zoster virus retinitis in patients with acquired immunodeficiency syndrome. Am J Ophthalmol 112:119, 1991

193. Engstrom RE Jr, Holland GN, Margolis TP et al: The progressive outer retinal necrosis syndrome: a variant of necrotizing herpetic retinopathy in patients with AIDS. Ophthalmology 101:1488, 1994

194. Short GA, Margolis TP, Kuppermann DB et al: A PCR based assay for the diagnosis of AIDS associated VZV retinitis. Am J Ophthalmol 123:157, 1997

195. Cunningham ET Jr, Short GA, Irvine AR et al: AIDS-associated herpes simplex virus retinitis: clinical description and use of a polymerase chain reaction-based assay as a diagnostic tool. Arch Ophthalmol 114:834, 1996

196. Rummelt V, Rummelt C, Gahn G et al: Triple retinal infection with human immunodeficiency virus type 1, cytomegalovirus, and herpes simplex type 1: light and electron microscopy, immunohistochemistry, and in situ hybridization. Ophthalmology 101:270, 1994

197. Holland GN, Engstrom RE, Glasglow BJ et al: Ocular toxoplasmosis in patients with the acquired immunodeficiency syndrome. Am J Ophthalmol 106:653, 1988

198. Grossniklaus HE, Specht CS, Allaire G, Leavitt JA: Toxoplasma gondii retinochoroiditis and optic neuritis in acquired immune deficiency syndrome. Ophthalmology 97:1342, 1990

199. Gagliuso DJ, Teich SA, Friedman AH, Orellana J: Ocular toxoplasmosis in AIDS patients. Trans Am Ophthalmol Soc 88:63, 1990

200. Cochereau-Massin I, LeHoang P, Lautier-Frau M et al: Ocular toxoplasmosis in human immunodeficiency virus-infected patients. Am J Ophthalmol 114:130, 1992

201. Berger BB, Egwuagu CE, Freeman WR, Wiley CAA: Miliary toxoplasmic retinitis in acquired immunodeficiency syndrome. Arch Ophthalmol 111:373, 1993

202. Zaidman GW: Neurosyphilis and retrobulbar neuritis in a patient with AIDS. Ann Ophthalmol 18:260, 1986

203. Johns DR, Tierney M, Felsenstein D: Alteration in the natural history of neurosyphilis by concurrent infection with the human immunodeficiency virus. N Engl J Med 316:1569, 1987

204. Berry CD, Hooton TM, Collier AC, Lukehart SA: Neurologic relapse after benzathine penicillin therapy for syphilis in a patient with HIV infection. N Engl J Med 316:1587, 1987

205. Carter JB, Hamill RJ, Matoba AY: Bilateral syphilitic optic neuritis in a patient with a positive test for HIV. Arch Ophthalmol 105:1485, 1987

206. Kleiner RC, Najarian L, Levenson J, Kaplan HJ: AIDS complicated by syphilis can mimic uveitis and Crohn's disease. Arch Ophthalmol 105:1486, 1987

207. Zambrano W, Perez GM, Smith JL: Acute syphilitic blindness in AIDS. J Clin Neuroophthalmol 7:1, 1987

208. Radolf JB, Kaplan RP: Unusual manifestations of secondary syphilis and abnormal humoral immune response to Treponema pallidum antigens in a homosexual man with asymptomatic human immunodeficiency virus infection. J Am Acad Dermatol 18:423, 1988

209. Passo MS, Rosenbaum JT: Ocular syphilis in patients with human immunodeficiency virus infection. Am J Ophthalmol 106:1, 1988

210. Richards BW, Hessburg TJ, Nussbaum JN: Recurrent syphilitic uveitis. N Engl J Med 320:62, 1989

211. Levy JH, Liss RA, Maguire AM: Neurosyphilis and ocular syphilis in patients with concurrent human immunodeficiency virus infection. Retina 9:175, 1989

212. Becerra LI, Ksiazek SM, Savino PJ et al: Syphilitic uveitis in human immunodeficiency virus-infected and non-infected patients. Ophthalmology 96:1727, 1989

213. Gass JBM, Braunstein RA, Chenoweth RG: Acute syphilitic posterior placoid chorioretinitis. Ophthalmology 97:1288, 1990

214. McLeish WM, Pulido JS, Holland S et al: The ocular manifestations of syphilis in the human immunodeficiency virus type 1--infected host. Ophthalmology 97:196, 1990

215. Tamesis RR, Foster CS: Ocular syphilis. Ophthalmology 97:1281, 1990

216. Pillai S, DePaolo F: Bilateral panuveitis, sebopsoriasis, and secondary syphilis in a patient with acquired immunodeficiency syndrome. Am J Ophthalmol 114:773, 1992

217. Halperin LS: Neuroretinitis due to seronegative syphilis associated with human immunodeficiency virus. J Clin Neuroophthalmology 12:171, 1992

218. Macher A, Rodrigues MM, Kaplan W et al: Disseminated bilateral chorioretinitis due to Histoplasma capsulatum in a patient with the acquired immunodeficiency syndrome. Ophthalmology 92:1159, 1985

219. Kurosawa A, Pollack SC, Collins MP et al: Sporothrix schenckii endophthalmitis in a patient with human immunodeficiency virus infection. Arch Ophthalmol 106:376, 1988

220. Davis JL, Nussenblatt RB, Bachman DM et al: Endogenous bacterial retinitis in AIDS. Am J Ophthalmol 107:613, 1989

221. Shivaram U, Cash M: Purpura fulminans, metastatic endophthalmitis, and thrombotic thrombocytopenic purpura in an HIV-infected patient. NY State J Med 92:313, 1992

222. Pavan PR, Margo CE: Endogenous endophthalmitis caused by Bipolaris hawaiienisis in a patient with acquired immunodeficiency syndrome. Am J Ophthalmol 116:644, 1993

223. Tufail A, Weisz JM, Holland GN: Endogenous bacterial endophthalmitis as a complication of intravenous therapy for cytomegalovirus retinopathy. Arch Ophthalmol 114:879, 1996

224. Glasgow BJ, Engstrom RE Jr, Holland GN et al: Bilateral endogenous Fusarium endophthalmitis associated with acquired immunodeficiency syndrome. Arch Ophthalmol 114:873, 1996

225. Walton CR, Wilson J, Chan C-C: Metastatic choroidal abscess in the acquired immunodeficiency syndrome. Arch Ophthalmol 114:880, 1996

226. Rehder JR, Burnier M, Pavesio CE et al: Acute unilateral toxoplasmic iridocyclitis in an AIDS patient. Am J Ophthalmol 106:740, 1988

227. Charles NC, Boxrud CA, Small EA: Cryptococcosis of the anterior segment in acquired immune deficiency syndrome. Ophthalmology 99:813, 1992

228. Chang M, van der Horst CM, Olney MS, Peiffer RL: Clinicopathologic correlation of ocular and neurologic findings in AIDS: case report. Ann Ophthalmol 18:105, 1986

229. Altman EM, Centeno LV, Mahal M, Bielory L: AIDS-associated Reiter's syndrome. Ann Allergy 72:307, 1994

230. Berenbaum F, Duvivier C, Prier A, Kaplan G: Successful treatment of Reiter's syndrome in a patient with AIDS with methotrexate and corticosteroids. Br J Rheumatol 35:295, 1996

231. Shafran SD, Deschenes J, Miller M et al: Uveitis and pseudojaundice during a regimen of clarithromycin, rifabutin, and ethambutol. N Engl J Med 330:438, 1994

232. Saran BR, Maguire AM, Nichols C et al: Hypopyon uveitis in patients with acquired immunodeficiency syndrome treated for systemic Mycobacterium avium complex infection with rifabutin. Arch Ophthalmol 112:1159, 1994

233. Tseng AL, Walmsley SL: Rifabutin-associated uveitis. Ann Pharmacother 29:1149, 1995

234. The HPMPC Peripheral Cytomegalovirus Retinitis Trial: Parenteral cidofovir for cytomegalovirus retinitis in patients with AIDS: a randomized, controlled trial: studies of Ocular complications of AIDS Research Group in Collaboration with the AIDS Clinical Trials Group. Ann Intern Med 126:264, 1997

235. Rahhal FM, Arevalo JF, Munguia D et al: Intravitreal cidofovir for the maintenance treatment of cytomegalovirus retinitis. Ophthalmology 103:1078, 1996

236. Ullman S, Wilson RP, Schwartz L: Bilateral angle-closure glaucoma in association with the acquired immune deficiency syndrome. Am J Ophthalmol 101:419, 1986

237. Williams AS, Williams FC, O'Donnell JJ: AIDS presenting as acute glaucoma. Arch Ophthalmol 106:311, 1988

238. Nash RW, Lindquist TD: Bilateral angle-closure glaucoma associated with uveal effusion: presenting sign of HIV infection. Surv Ophthalmol 36:255, 1992

239. Krzystolik MG, Kuperwasser M, Low RM, Dreyer EB: Anterior-segment ultrasound biomicroscopy in a patient with AIDS and bilateral angle-closure glaucoma secondary to uveal effusions. Arch Ophthalmol 114:878, 1996

240. Gass JDM: Uveal effusion syndrome: A new hypothesis concerning pathogenesis and technique of surgical treatment. Retina 3:159, 1983

241. Freeman WR, Chen A, Henderly DE et al: Prevalence and significance of acquired immunodeficiency syndrome-related retinal microvasculopathy. Am J Ophthalmol 107:229, 1989

242. Glasgow BJ, Weisberger AK: A quantitative and cartographic study of retinal microvasculopathy in acquired immunodeficiency syndrome. Am J Ophthalmol 118:46, 1994

243. Newsome DA, Green WR, Miller ED et al: Microvascular aspects of acquired immune deficiency syndrome retinopathy. Am J Ophthalmol 98:590, 1984

244. Tenhula WN, Xu S, Madigan MC et al: Morphometric comparisons of optic nerve axon loss in acquired immunodeficiency syndrome. Am J Ophthalmol 113:14, 1992

245. Sadun AA, Pepose JS, Madigan MC et al: AIDS-related optic neuropathy: a histological, virological and ultrastructural study. Graefes Arch Clin Exp Ophthalmol 233:387, 1995

246. Latkany PA, Holopigian K, Lorenzo-Latkany M, Seiple W: Electroretinographic and psychophysical findings during early and late stages of human immunodeficiency virus infection and cytomegalovirus retinitis. Ophthalmology 104:445, 1997

247. Quiceno JI, Capparelli E, Sadun AA et al: Visual dysfunction without retinitis in patients with acquired immunodeficiency syndrome. Am J Ophthalmol 113:8, 1992

248. Plummer DJ, Sample PA, Arevalo JF et al: Visual field loss in HIV-positive patients without infectious retinopathy. Am J Ophthalmol 122:542, 1996

249. Gonzalez CR, Wiley CA, Arevalo JF et al: Polymerase chain reaction detection of cytomegalovirus and human immunodeficiency virus-1 in the retina of patients with acquired immune deficiency syndrome with and without cotton-wool spots. Retina 16:305, 1996

250. Freeman WR: New developments in the treatment of CMV retinitis. Ophthalmology 103:999, 1996

251. Jabs DA: Treatment of cytomegalovirus retinitis in patients with AIDS. Ann Intern Med 125:144, 1996

252. Engstrom RE Jr, Holland GN: Local therapy for cytomegalovirus retinopathy. Am J Ophthalmol 120:376, 1995

253. Cunningham ET Jr: New Treatments for CMV retinitis in patients with AIDS. West J Med 166:138, 1997

254. Moorthy RS, Smith RE, Rao NA: Progressive ocular toxoplasmosis in patients with acquired immunodeficiency syndrome. Am J Ophthalmol 115:742, 1993

255. Elkins BS, Holland GN, Opremcak EM et al: Ocular toxoplasmosis misdiagnosed as cytomegalovirus retinopathy in immunocompromised patients. Ophthalmology 101:499, 1994

256. Wei ME, Campbell SH, Taylor C: Precipitous visual loss secondary to optic nerve toxoplasmosis as an unusual presentation of AIDS. Austr NZ J Ophthalmol 24:75, 1996

257. Lopez JS, de Smet MD, Masur H et al: Orally administered 566C80 for treatment of ocular toxoplasmosis in a patient with the acquired immunodeficiency syndrome. Am J Ophthalmol 113:331, 1992

258. Schlossberg D, Morad Y, Krouse TB et al: Culture-proved disseminated cat-scratch disease in acquired immunodeficiency syndrome. Arch Intern Med 149:1437, 1989

259. Wong MT, Dolan MJ, Lattuada CP Jr et al: Neuroretinitis, aseptic meningitis, and lymphadenitis associated with Bartonella (Rochalimaea) henselae infection in immunocompetent patients and patients infected with human immunodeficiency virus type I. Clin Infect Dis 21:352, 1995

260. Rao NA, Zimmerman PL, Boyer D et al: A clinical, histological, and electron microscopic study of Pneumocystis carinii choroiditis. Am J Ophthalmol 107:218, 1989

261. Shami MJ, Freeman W, Friedberg D et al: A multicenter study of Pneumocystis choroidopathy. Am J Ophthalmol 112:15, 1991

262. Kestelyn P, Taelman H, Bogaerts J et al: Ophthalmic manifestations of infection with Cryptococcus neoformans in patients with the acquired immunodeficiency syndrome. Am J Ophthalmol 116:721, 1993

263. Muccioli C, Belfort R Jr, Rao N: Limbal and choroidal cryptococcus infection in the acquired immunodeficiency syndrome. Am J Ophthalmol 120:539, 1995

264. Saran BR, Pomilla PV: Retinal vascular nonperfusion and retinal neovascularization as a consequence of cytomegalovirus retinitis and cryptococcal choroiditis. Retina 16:510, 1996

265. Schanzer MC, Font RL, O'Malley RE: Primary ocular malignant lymphoma associated with the acquired immunodeficiency syndrome. Ophthalmology 98:88, 1991

266. Stanton CA, Sloan DB III, Slusher MM, Greven CM: Acquired immunodeficiency syndrome-related primary intraocular lymphoma. Arch Ophthalmol 110:1614, 1992

267. Matzkin DC, Slamovits TL, Rosenbaum PS: Simultaneous intraocular and orbital non-Hodgkin lymphoma in acquired immune deficiency syndrome. Ophthalmology 101:850, 1994

268. Fujikawa LS, Schwartz LK, Rosenbaum EH: Acquired immunodeficiency syndrome associated with Burkitt's lymphoma presenting with ocular findings. Ophthalmology 90(suppl):50, 1983

269. Tien DR: Large cell lymphoma in AIDS. Ophthalmology 98:412, 1991

270. Antle CM, White VA, Horsman DE, Rootman J: Large cell orbital lymphoma in a patient with acquired immune deficiency syndrome: case report and review. Ophthalmology 97:1484, 1990

271. Mansour AM: Orbital findings in acquired immunodeficiency syndrome. Am J Ophthalmol 110:706, 1990

272. Brooks HL Jr, Downing J, McClure JA, Engel HM: Orbital Burkitt's lymphoma in a homosexual man with acquired immune deficiency. Arch Ophthalmol 102:1533, 1984

273. Font RL, Laucirica R, Patrimely JR: Immunoblastic B-cell malignant lymphoma involving the orbit and maxillary sinus in a patient with acquired immune deficiency syndrome. Ophthalmology 100:966, 1993

274. Kronish JW, Johnson TE, Gilberg SM et al: Orbital infections in patients with human immunodeficiency syndrome. Ophthalmology 103:1483, 1996

275. Vitale AT, Spaide RF, Warren FA et al: Orbital aspergillosis in an immunocompromised host. Am J Ophthalmol 113:725, 1992

276. Cahill KV, Hogan CD, Koletar SL, Gersman M: Intraorbital injection of amphotericin B for palliative treatment of Aspergillus orbital abscess. Ophthalmic Plast Reconstr Surg 10:276, 1994

277. Friedberg DN, Warren FA, Lee MH et al: Pneumocystis carinii of the orbit. Am J Ophthalmol 113:595, 1992

278. Cano-Parra J, Espana E, Esteban M et al: Pseudomonas conjunctival ulcer and secondary orbital cellulitis in a patient with AIDS. Br J Ophthalmol 78:72, 1994

279. Cheung SW, Lee KC, Cha I: Orbitocerebral complications of Pseudomonas sinusitis. Laryngoscope 102:1385, 1992

280. Meyer RD, Gaultier Cr, Yamashita JT et al: Fungal sinusitis in patients with AIDS: report of 4 cases and review of the literature. Medicine 73:69, 1994

281. Blatt SP, Lucey DR, DeHoff D, Zellmer RB: Rhinocerebral zygomycosis in a patient with AIDS. J Infect Dis 164:215, 1991

282. Benson WH, Linberg JV, Weinstein GW: Orbital pseudotumor in a patient with AIDS. Am J Ophthalmol 105:697, 1988

283. Fabricius EM, Hoegl I, Pfaeffl W: Ocular myositis as first presenting symptom of human immunodeficiency virus (HIV-1) infection and its response to high-dose cortisone treatment. Br J Ophthalmol 75:696, 1991

284. Gross FJ, Waxman JS, Rosenblatt MA et al: Eosinophilic granuloma of the cavernous sinus and orbital apex in an HIV-positive patient. Ophthalmology 96:462, 1989

285. Singer MA, Warren F, Accardi F et al: Adenocarcinoma of the stomach confirmed by orbital biopsy in a patient seropositive for human immunodeficiency virus. Am J Ophthalmol 110:707, 1990

286. Ormerod LD, Rhodes RH, Gross SA et al: Ophthalmic manifestations of acquired immune deficiency syndrome-associated progressive multifocal leukoencephalopathy. Ophthalmology 103:889, 1996

287. Englund JA, Baker CJ, Raskino C et al: Clinical and laboratory characteristics of a large cohort of symptomatic, human immunodeficiency virus-infected infants and children. Pediatr Infect Dis J 15:1025, 1996

288. Baumal CR, Levin AV, Kavalec CC et al: Screening for cytomegalovirus retinitis in children. Arch Pediatr Adolesc Med 150:1186, 1996

289. Bremond-Gignac D, Aron-Rosa D, Rohrlich P et al: Cytomegalovirus retinitis in children with AIDS acquired through materno-fetal transmission. J Fr Ophtalmol 18:91, 1995

290. Falloon J, Eddy J, Wiener L et al: Human immunodeficiency virus infection in children. J Pediatr 144:1, 1989

291. Wiznia AA, Lambert G, Pavlakis S: Pediatric HIV infection. Med Clin North Am 80:1309, 1996

292. Marion MW, Wiznia AA, Hutcheon RG, Rubenstein A: Human T-cell lymphotropic virus type II (HTLV-III) embryopathy. Am J Dis Child 140:638, 1986

293. Marion MW, Wiznia AA, Hutcheon G, Rubinstein A: Fetal AIDS syndrome score: correlation between severity of dysmorphism and age at diagnosis of immunodeficiency. Am J Dis Child 141:429, 1987

294. Whitcup SM, Butler KM, Caruso R et al: Retinal toxicity in human immunodeficiency virus-infected children treated with 2',3'-dideoxyinosine. Am J Ophthalmol 113:1, 1992

295. Whitcup SM, Dastgheib K, Nussenblatt RB et al: A clinicopathologic report of the retinal lesions associated with didanosine. Arch Ophthalmol 112:1594, 1994

296. Wilhelmus KR, Keener MJ, Jones DB, Font RL: Corneal lipidosis in patients with the acquired immunodeficiency syndrome. Am J Ophthalmol 119:14, 1995

297. Shah GK, Cantrill HL, Holland EJ: Vortex keratopathy associated with atovaquone. Am J Ophthalmol 120:669, 1995

Back to Top