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HIV and Your Eyes

Medically Reviewed by Alan Kozarsky, MD on June 10, 2020

HIV affects many parts of your body, and your eyes are no exception. Many of the vision problems the virus can cause become less likely the more you can keep your condition under control. Still, its important for everyone with HIV to pay attention to their eye health with regular eye exams and by watching for signs of vision trouble. Here are the most common conditions to be aware of.

HIV retinopathy. It happens when HIV damages the retina, the lining of the back of the eye. When you have HIV, that damage usually comes from infections, inflammation, and blood vessel damage.

During an eye exam, your doctor may find broken blood vessels or cotton wool” spots, named because they look white and fluffy. They dont usually affect eyesight or need treatment, but you could notice a narrower field of vision and changes in how well you see colors and contrasts.

CMV retinitis. This condition happens when cytomegalovirus (CMV) causes inflammation that damages the retina. It usually affects people whose HIV has progressed to the more advanced stages of AIDS. Its a serious condition, but thanks to modern HIV medicines, its far less common than it used to be.

Contact your eye doctor right away if you notice the signs -- floating spots, flashes, blurred vision, or blind spots. CMV doesn’t always cause symptoms, but your eye doctor can see telltale signs during an exam. You can control CMV retinitis with antiviral drugs like ganciclovir and valganciclovir.

Immune recovery uveitis (IRU). This is inflammation of the uvea, the middle layer of the eye. Its a side effect of treatment for up to 60% of people with HIV whove had CMV retinitis. IRU can lead to other eye problems like cataracts, glaucoma, and ocular hypertension (high blood pressure in the eyes). Mild IRU often goes away on its own, but if you have severe inflammation or symptoms, like seeing floating spots, blurred vision, and eye pain, you might need treatment with steroids.

Herpes zoster ophthalmicus (HZO). Anyone who’s ever had the chickenpox virus can get this infection. It affects between 5% and 15% of people with HIV. It causes painful blisters that crust over, often on the eyes and face. It often leads to inflammation in one or more parts of the eye, such as the iris -- the colored part of your eye -- and, rarely, the cornea. Antiviral medicines, like acyclovir, famciclovir, or valacyclovir, can help.

Kaposi sarcoma is a form of cancer linked to HIV and known for its purple-red growths on skin. About 1 in 5 people who have it will get the growths on their eyelids or whites of the eyes. They usually aren’t painful or harmful to the eye, but if they bother you or cause changes to your vision, you may be able to have surgery to remove them. To treat Kaposi sarcoma itself, your doctor will recommend antiretroviral therapy (ART), chemotherapy, biologics, or a mix of these medicines.

Squamous cell carcinoma. This type of cancer can form in the tissue that covers the front of the eyes and the insides of the eyelids. Treatment with fluorouracil, a chemotherapy drug that you can put directly on your eye, works well, especially in the early stages.

Dry eyes. About 20% of people with HIV have dry eyes. The virus harms the glands that make tears. Blepharitis, an inflammation of the eyelid thats also common with HIV, can make the dryness worse. Artificial tears and eye lubricants can help.

Infections. You may be more likely to get other types of infections that affect your eyes, such as:

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Dont wait for symptoms to appear to see your eye doctor. Get regular checkups. Some HIV-related eye infections dont 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 3 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
WebMD Medical Reference

Sources

SOURCES:

Stat Pearls: “Ocular Manifestations of HIV,” “HIV Retinopathy.”

American Academy of Ophthalmology: “HIV and the Eye: Lessons Learned, Challenges Remain,”“How Does HIV/AIDS Affect the Eye?”

Journal of Ophthalmic Inflammation and Infection: “Immune recovery uveitis in HIV patients with cytomegalovirus retinitis in the era of HAART therapy—a 5-year study from Singapore.”

Prevent Blindness: “Eye Diseases and Conditions: HIV/AIDS and the Eye.”

UCLA Health: “HIV-Related Eye Problems.”

University of California San Francisco/HIV InSite: “Ophthalmic Manifestations of HIV.”

National Cancer Institute: “Kaposi Sarcoma Treatment.”

British Journal of Ophthalmology: “Topical 1% 5-fluoruracil as a Sole Treatment of Corneoconjunctival Ocular Surface Squamous Neoplasia: Long-Term Study.”

PLOSOne: “Anterior segment and external ocular disorders associated with HIV infections in the era of HAART in Chiang Mai University Hospital, a prospective descriptive cross sectional study.”

Advances in Ophthalmology and Optometry: “Follow-up on the Longitudinal Study of the Ocular Complications of Human Immunodeficiency Virus/AIDS.”

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