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20 - Ophthalmic problems

Published online by Cambridge University Press:  23 December 2009

By
Howard F. Fine ,
Susan S. Lee  and
Michael R. Robinson
Edited by
Steven L. Zeichner  and
Jennifer S. Read
Howard F. Fine
Affiliation:
Ophthalmology, Wilmer Eye Institute, Johns Hopkins, Baltimore, M. D.
Susan S. Lee
Affiliation:
National Eye Institute, NIH, Bethesda, M. D.
Michael R. Robinson
Affiliation:
National Eye Institute, NIH, Bethesda, M. D.
Steven L. Zeichner
Affiliation:
National Cancer Institute, Bethesda, Maryland
Jennifer S. Read
Affiliation:
National Institutes of Health, Bethesda, Maryland
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Summary

Introduction

Ophthalmic disease is common in patients with HIV infection, occurring in up to 75% of patients over the course of their illness [1]. As in other organ systems, a hallmark of the ocular sequelae of HIV infection is the presence of opportunistic infections by bacteria, viruses, fungi, and parasites, which may occur in up to 30% of HIV-positive individuals [2, 3]. HIV-positive children may acquire infections that are also common in immunocompetent patients, although the severity is often greatly increased.

Because children rarely complain of ocular symptoms, eye disease such as cytomegalovirus (CMV) retinitis, is often diagnosed at a more advanced stage. This chapter gives an overview of the ocular manifestations of HIV in children.

Epidemiology

Ophthalmologic disease in HIV-infected children can involve any part of the eye. The ocular manifestations of HIV infection in children are listed in Table 20.1; few of the disorders occur in more than 5% of children. The most common ophthalmologic diseases in HIV-infected children affect the posterior segment (vitreous, retina, and choroid).

Clinical examination

Routine screening eye examinations are suggested because sight-threatening complications like CMV retinitis can be asymptomatic, and early diagnosis and treatment can prevent loss of sight. Sight-threatening diseases occur most frequently in children with advanced HIV infection and low CD4+ lymphocyte counts. Regular screening examinations should be performed by an experienced ophthalmologist according to Table 20.2 [4].

Information

Type
Chapter
Information
Handbook of Pediatric HIV Care , pp. 520 - 534
Publisher: Cambridge University Press
Print publication year: 2006

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