HIV Retinopathy and Other HIV-Related Eye Conditions

By Anna Barden; reviewed by Darryl Glover, OD

HIV and how it affects the eyes

HIV (human immunodeficiency virus) is a virus that attacks white blood cells called lymphocytes (T-cells) in the body’s immune system. It is caused by infected bodily fluids, such as semen, blood, breastmilk and vaginal fluids, passed from one person to another.

The body’s T-cells are needed to fight off infections such as the common cold, flu and various viruses. But when HIV attaches itself to a T-cell, it begins multiplying. And it eventually kills the T-cell entirely. This makes the body extremely weak against the aforementioned viruses.

A person who has HIV may contract AIDS (acquired immunodeficiency syndrome) after losing their T-cells. AIDS is a life-threatening disease, but there is treatment available for the medical problems it can cause.

Both HIV and AIDS prevent the body from fighting infections and viruses. And for many people, that includes conditions related to the eye. According to Prevent Blindness, as many as 70% of HIV patients develop eye problems.

This can range from dry eye and infections to HIV retinopathy to a number of other conditions. This is in addition to all the uncomfortable symptoms these issues are accompanied by.

HIV retinopathy

Retinopathy is a term for any disease that occurs in the retina — the light-sensitive tissue located at the back of the eye. It’s also used to describe the damage present in the retina due to diseases such as diabetes and hypertension.

HIV can also cause retinopathy, referred to as HIV retinopathy or HIV microvasculopathy. (Microvasculopathy is a disease of the small blood vessels in the brain, including the retina.)

Experts note that HIV can cause the blood vessels located in the retina to break or become blocked, leading to complications. For example, when the blood vessels are blocked, it can cause white, cotton-wool spots to form on the retina. (Cotton-wool spots are one of the key features of HIV retinopathy.)

These blocked or broken blood vessels can also cause retinal bleeding, which may lead to serious eye damage. But, many HIV patients experiencing maculovasculopathy (including retinopathy) are actually asymptomatic. When this is true, treatment may be unnecessary.

But HIV itself requires treatment and monitoring from both a medical doctor and an eye doctor to prevent complications.

Additional HIV eye problems

Of all eye problems that one with HIV may experience, HIV retinopathy is the most common. But there are several other eye conditions that can occur in people with HIV.

This includes the following:

Secondary eye issues can also occur due to these conditions.

Cytomegalovirus (CMV) retinitis

Cytomegalovirus (CMV) retinitis is a critical eye condition in people with more advanced forms of HIV or AIDS. This is particularly true in those who have lost a significant amount of T-cells. CMV affects the retinas and can cause bleeding, inflammation in the retina and vision loss.

CMV can also cause retinal detachment, which can lead to blindness as well.

While CMV cannot be cured, it can be treated with medication prescribed by your doctor. It’s important to treat CMV promptly, as blindness can set in within months. Call your eye doctor as soon as possible if you experience flashes of light, blurred vision or floaters. All of these can be symptoms of CMV.

READ MORE ABOUT types of retinal detachment.

Herpes zoster ophthalmicus (HZO)

If the chickenpox virus is reactivated in the system, it can cause complications such as herpes zoster ophthalmicus (HZO). HZO is a type of herpes virus that affects the eyes. The condition can occur in people with HIV, as well as adults over 60 years old.

HZO causes a painful, crusty or blister-like rash in those who are infected. It can also cause vision loss.

Herpes zoster can affect other parts of the body with the same symptoms, though it is most often found in the face and eyes.

Squamous cell carcinoma of the conjunctiva

HIV and AIDS are among several conditions associated with squamous cell carcinoma of the conjunctiva. This is a malignant tumor on the conjunctiva (the white part of the eye). It’s also associated with ultraviolet radiation, human papillomavirus (HPV) and allergic conjunctivitis.

The disease produces a painless white growth on the surface of the conjunctiva. It can also cause symptoms such as light sensitivity, redness and a foreign body sensation in the eye.

Squamous cell carcinoma of the conjunctiva is one effect of ocular surface squamous neoplasia (OSSN). OSSN is a complex condition that can lead to vision loss and even death in some cases.

Kaposi sarcoma

In rare cases, a person with HIV or AIDS can develop a red or purplish tumor on the conjunctiva or eyelid. This is called Kaposi sarcoma, and although cancerous, it is usually treatable and harmless.

Kaposi sarcoma can also occur in the mouth or on the skin.

Symptoms of HIV eye problems

Symptoms are not always obvious in HIV-caused eye issues. Sometimes they go unnoticed until the condition itself worsens. For this reason, seeing an eye doctor on a yearly basis for a routine eye exam is crucial.

That said, there are a number of symptoms that are associated with HIV eye problems. This can include:

These factors may vary depending on the condition that is present. Don’t hesitate to contact your eye doctor or primary care provider if you experience any of these issues. The same goes for any eye issues that may not be listed. It’s important to treat eye symptoms as soon as possible so they don’t get worse.

Diagnosis of HIV retinopathy and other eye conditions

An eye doctor can diagnose HIV retinopathy and other HIV eye problems during a comprehensive eye exam. You should have one of these exams once a year. But you may need to see your eye doctor more often, depending on your condition. Immunodeficiency conditions can largely impact the eyes.

Contact your eye care provider as soon as possible if you have HIV and begin to notice any eye symptoms. This is true whether or not it is time for your annual exam.

Treating HIV-associated eye conditions

Treatment for HIV eye problems depends on which condition is present and how severe it is.

Some treatments include:

Surgery or radiation to treat eye tumors (such as squamous cell carcinoma of the conjunctiva)
Surgery or laser treatment to address retinal damage such as swelling or bleeding in the eye
Special medications to treat HIV eye infections

Your doctor will let you know what the best treatment plan is for your condition. Antiviral medications prescribed for HIV patients can also help prevent complications. This includes eye conditions.

Certain HIV-related eye infections may also be treated with antibiotics. Plus, home remedies such as cool compresses may relieve discomfort.

Keep up with routine eye exams

HIV eye problems are serious and must be treated promptly to prevent permanent eye damage. Since HIV affects the immune system, eye conditions are common.

A person with HIV also faces a greater risk for eye infections. Examples include Candida, microsporidia, gonorrhea, toxoplasmosis and more. Chlamydia of the eye is also commonly contracted among HIV patients.

Regular eye exams can help prevent, diagnose and treat many of these conditions. And as with most health issues, early diagnosis and treatment are best.

It’s crucial to see an ophthalmologist once a year for a regular vision check-up. Some people may require additional monitoring of their eye health. Both HIV eye conditions and infections can potentially lead to vision loss if they are not treated quickly and appropriately.

Ask your doctor if you should be concerned about your condition. They will guide you through managing your symptoms and any vision issues that may arise.

Page published on Thursday, July 7, 2022

Medically reviewed on Sunday, June 5, 2022