RETINITIS IN AIDS PATIENTS - Occurs in approx. Half of AIDS pts - Usually a complication of opportunistic infection—most are believed to be reactivation of previous infection
HIV RETINOPATHY - Cotton wool retinal lesions that are rarely hemorrhagic - Usually resolves over weeks to months - Usually no floaters or blurred vision
CMV RETINITIS - Most common serious complication of HIV pts - CMV causes asymptomatic initial infection but causes lifelong latent infection - Pts with significantly compromised cell-mediated immunity (e.g. advanced HIV with CD4 <100/mm3) reactivation of CMV may cause viremia or end-organ disease - CMV retinitis: characterized by full-thickness retinal inflammation that moves centripetally along the vasculature edema and scarring - C/F: blurred vision, floaters and photopsia (sensation of flashing lights)—painless , not usually associated with keratitis or conjunctivitis - Lesions near fovea and optic nerve can cause blindness - Scarring ↑es risk of retinal detachment - Dx: Fundoscopy: yellow-white, fluffy, hemorrhagic lesions along the vasculature.
Blood tests for CMV (polymerase chain reaction)—not sufficient for diagnosis as viremia may develop independently of end-organ disease. - Rx:
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Usually treated with oral antivirals (eg, valganciclovir); if lesions are near the fovea or optic nerve, intravitreal injections are added. All patients should be initiated on antiretroviral therapy (usually 2 weeks after beginning CMV treatment) to prevent recurrence and progression HSV AND VZV RETINITIS - Both VZV and HSV cause severe devastating intraocular inflammation (severe, acute retinal necrosis) - In an immunocompromised individual, HSV retinitis may be characterized by rapidly progressing bilateral necrotizing retinitis (referred to as the “acute retinal necrosis syndrome”) - Initial symptoms: keratitis, uveitis and conjunctivitis with eye pain, followed by rapidly progressive visual loss. - Funduscopy reveals widespread, pale, peripheral lesions and central necrosis of the retina - HSV infection of the eye is the most common cause of corneal blindness in the United States. TOXOPLASMIC CHORIORETINITIS - Causes eye pain and ↓ vision - Retinal lesions occur in non-vascular distribution
SYPHILITIC CHORIORETINITIS - Usually presents with uveitis and diminished visual acuity - Almost always occurs with syphilitic meningitis.