OCULAR LESIONS IN AIDS
*OCULAR ADNEXA-
HERPES ZOSTER OPHTHALMICUS-
Varicella zoster
UL
Any age
More sev in immunocompromised
C/F- Pain –V N
-Maculopapular rash on forehead→vesicles→pustules→crusting ulceration
-Periorbital edema
* T/T-
Systemic-
1. T.Acyclovir 1gm TDS Or
2. T. Famciclovir 250mg TDS / 750 mg OD
Topical-
1. acyclovir cream 3% TDS
2. Hydrocortisone 1 % + Fusidic acid 2% or Oxytetracycline 3% till crusts separate.
KAPOSI’S SARCOMA-
Human herpes virus-8
Affects lids & conj
Vascular tum
Pink, red-violet to brown small lesion or large , rapidly growing tum that may ulcerate & bleed
T/T- RT or Excision
MOLLUSCUM CONTAGIOSUM-
Pox virus
Pale, waxy, umbilicated nodule.
IL chr follicular c’vitis [ d/t viral shedding in fornix]
T/T- 1. Shave excision
2. Cautery /cryo /laser
Conjunctival microvasculopathy
Sludging, dilated, tortuous, comma shaped Vs
Allergic C’vitis
*ANTERIOR SEGMENT LESION-
DRY EYE-
D/T- systemic malabsorption of nutrients to maintain a healthy tear film / toxicity from sys drugs.
Burning sensation & watering
T/T- Tear subs & punctual occlusion
INFECTIVE KERATITIS-
HERPES ZOSTER OPHTHALMICUS-
Acute phase-
Skin rash
Pain
Influenza like illness
Keratitis-
Acute epithelial keratitis- Dendrite / stellate lesion
Nummular keratitis- Subepithelial deposits surrounded by halo of stromal haze
Disciform keratitis
Chronic phase-
Keratitis-
Nummular keratitis- Peripheral lesions form facets which become vascularized & infiltrated with lipids
Disciform keratitis
Neurotrophic keratitis- Ulceration→sec bact inf→ perforation
Mucus plaque keratitis
Recurrent phase.
T/T-
T. Aciclovir 800mg 5 times / day for 10 days
Oral analgesics
Topical Hydrocortisone 1% + Fusidic acid 2 % [ or oxytetracycline3 %] till the crusts separate
HERPES SIMPLEX KERATITIS-
Herpes virus DNA
Primary ocular infection-
Follicular C’vitis
Blepharoconjunctivitis
Sec canalicular obstrn
Epithelial keratitis-
Dendritic ulcer- Linear branching ulcer with terminal end-bulbs.
Disciform keratitis-
-Central zone of epith edema overlying stromal thickening
- Surrounding Wessely’s ring of stromal ppts
Stromal necrotic keratitis-
-Cheesy necrotic stroma
-Ant uveitis with KPs underlying active stromal infiltration
T/T-
T Aciclovir 400mg 5 /day
Topical- Aciclovir e/o- 3 %- 5 / day for 14 days
- Ganciclovir 0.15 % e/ gel 5/ day
- Trifluorothymidine 1 % e/d 2 hrly
Debridement
MICROSPORIDIAL KERATITIS-
Obligate intracellular protozoa
Bil diffuse chr. Punctate epith keratoconjunctivitis
T/t- Topical Fumagillin
-Oral Albendazole
- HAART
*POSTERIOR SEGMENT LESIONS-
HIV RETINOPATHY-
CW spots- MC- result from occlusion of precapillary
arterioles
-No effect on V/A
- No T/T
Intraretinal h’age
Ret telangiectasia
Vascular tortuosity
Venous / arteriolar occlusion
CMV RETINITIS-
Folder- uvea-pg6
PORN [ uvea-pg7], ARN [uvea-pg8], Toxoplasma [uvea pg9]
FUNGAL ENDOPHTHALMITIS-
CANDIDA CHORIORETINITIS-
Unilateral
Ocular pain
DOV
Floaters
White, fluffy, chorioretinal lesions with overlying vitritis
Inf can spread into vitreous-white snow-ball like or cotton ball opacities
Satellite lesion adjacent to prim lesion
T/T- IV Amphotericin B 1 gm for 4-6 wks
-5-Fluorocytosine 150mg/kg daily
-Ketoconazole 200-400mg/day
-If no response→ PPV + Intravitreal Amphotericin-B 5μg/0.1ml
PNEUMOCYSTITIS CARINII CHOROIDOPATHY-
Extrapulmonary dissemination→ choroidal inv
Seen in pts receiving inhaled aerosolized pentamidine
BL
Flat, yellow,round choroidal lesions
Vitreous NOT inv
V/A not impaired even in subfoveal inv
T/T- IV cotrimoxazole [ Trimethoprim + sulphamethoxazole ] or pentamidine.
CRYPTOCOCCUS CHOROIDITIS-
Multifocal , yellow-white, choroidal lesions
Small glistening spheres at vitreoretinal interface
ON inv→ Rapid visual loss
T/T- IV Amphotericin-B 1gm
-Endoph- IV Amphotericin B + PPV
*ORBIT-
- burkitt’s lymphoma
- orbital cellulites
*NEUROPHTHALMOLOGY-
- Cranial N palsy
-Papilloedema
-OA
-Lagophthalmos
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