Ophthalmic problems

doi:10.1017/CBO9780511544798.030

27 - Ophthalmic problems

from Part IV - Clinical manifestations of HIV infection in children

Published online by Cambridge University Press: 03 February 2010

Howard F. Fine ,

Susan S. Lee and

Michael R. Robinson

Edited by

Steven L. Zeichner and

Jennifer S. Read

Show author details

Howard F. Fine: Affiliation:
Ophthalmology, Wilmer Eye Institute, Johns Hopkins, Baltimore, MD
Susan S. Lee: Affiliation:
National Eye Institute, NIH, Bethesda, MD
Michael R. Robinson: Affiliation:
National Eye Institute, NIH, Bethesda, MD
Steven L. Zeichner: Affiliation:
National Cancer Institute, Bethesda, Maryland
Jennifer S. Read: Affiliation:
National Cancer Institute, Bethesda, Maryland

Book contents

Get access

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 27.1; few of the disorders occur in more than 5% of children. The most common ophthalmologic disease in HIV-infected children affects 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 27.2 [4].

Information

Type: Chapter
Information: Textbook of Pediatric HIV Care , pp. 445 - 454

DOI: https://doi.org/10.1017/CBO9780511544798.030 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2005

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

Mines, J. A. & Kaplan, H. J.Acquired immunodeficiency syndrome (Acquired Immune Deficiency Syndrome): the disease and its ocular manifestations. Int. Ophthalmol. Clin. 26: 2 (1986), 73–115CrossRef Google Scholar PubMed

Robinson, M. R., Ross, M. L. & Whitcup, S. M.Ocular manifestations of Human Immunodeficiency Virus infection. Curr. Opin. Ophthalmol 10: 6 (1999), 431–7CrossRef Google Scholar

Kronish, J. W., Johnson, T. E., Gilberg, S. M., Corrent, G. F., McLeish, W. M. & Scott, K. R.Orbital infections in patients with human immunodeficiency virus infection. Ophthalmology 103: 9 (1996), 1483–92CrossRef Google Scholar PubMed

Pizzo, P. A. & Wilfert, C. A (eds.). Ocular Manifestations of Human Immunodeficiency Virus in the Pediatric Population, 3 edn. Baltimore: Williams & Wilkins (1998)

Robinson, M. R., Udell, I. J., Garber, P. F., Perry, H. D., & Streeten, B. W.Molluscum contagiosum of the eyelids in patients with acquired immune deficiency syndrome. Ophthalmology 99: 11 (1992), 1745–7CrossRef Google Scholar PubMed

Pelaez, C. A., Gurbindo, M. D., Cortes, C. & Munoz-Fernandez, M. A.Molluscum contagiosum, involving the upper eyelids, in a child infected with Human Immunodeficiency Virus-1. Pediatr. Acquired Immune Deficiency Syndrome Human Immunodeficiency Virus Infect. 7: 1 (1996), 43–6Google Scholar

Strauss, R. M., Doyle, E. L., Mohsen, A. H. & Green, S. T.Successful treatment of molluscum contagiosum with topical imiquimod in a severely immunocompromised Human Immunodeficiency Virus-positive patient. Int. J. STD Acquired Immune Deficiency Syndrome 12: 4 (2001), 264–6Google Scholar

Patrizi, A., Neri, I., Trestini, D., Landi, C., Ricci, G. & Masi, M.Acquired trichomegaly of the eyelashes in a child with human immunodeficiency virus infection. J. Eur. Acad. Dermatol. Venereol. 11: 1 (1998), 89–91CrossRef Google Scholar

Cunningham, E. T. Jr. & Margolis, T. P.Ocular manifestations of Human Immunodeficiency Virus infection. New Engl. J. Med. 339: 4 (1998), 236–44CrossRef Google Scholar

Chern, K. C., Conrad, D., Holland, G. N., Holsclaw, D. S., Schwartz, L. K. & Margolis, T. P.Chronic varicella-zoster virus epithelial keratitis in patients with acquired immunodeficiency syndrome. Arch. Ophthalmol. 116: 8 (1998), 1011–17CrossRef Google Scholar PubMed

Martins, S. A., Muccioli, C., Belfort, R Jr. & Castelo, A.Resolution of microsporidial keratoconjunctivitis in an Acquired Immune Deficiency Syndrome patient treated with highly active antiretroviral therapy. Am. J. Ophthalmol. 131: 3 (2001), 378–9CrossRef Google Scholar

Du, L. T., Coats, D. K., Kline, M. W.. Incidence of presumed cytomegalovirus retinitis in Human Immunodeficiency Virus-infected pediatric patients. J American Academy of PediatricsoS 3: 4 (1999), 245–9Google Scholar

Kanski, J. J. Clinical Ophthalmology: A Systemic Approach. 4 edn. Boston: Butterworth Heinemann Publishers (1999)

Rhegmatogenous retinal detachment in patients with cytomegalovirus retinitis: the Foscarnet—Ganciclovir Cytomegalovirus Retinitis Trial. The Studies of Ocular Complications of Acquired Immune Deficiency Syndrome (SOCA) Research Group in Collaboration with the Acquired Immune Deficiency Syndrome Clinical Trials Group (Acquired Immune Deficiency Syndrome Clinical Trials Group). Am. J. Ophthalmol. 124: 1 (1997), 61–70

Kempen, J. H., Jabs, D. A., Dunn, J. P., West, S. K. & Tonascia, J.Retinal detachment risk in cytomegalovirus retinitis related to the acquired immunodeficiency syndrome. Arch. Ophthalmol. 119: 1 (2001), 33–40Google Scholar PubMed

Whitcup, S. M., Fortin, E., Lindblad, A. S.. Discontinuation of anticytomegalovirus therapy in patients with Human Immunodeficiency Virus infection and cytomegalovirus netinitis. J. Am. Med. Assoc. 282: 17 (1999), 1633–7CrossRef Google Scholar

Martin, D. F., Sierra-Madero, J, . Walmsley, S., et al.A controlled trial of valganciclovir as induction therapy for cytomegalovirus retinitis. New Engl. J. Med. 346: 15 (2002), 1119–26CrossRef Google Scholar PubMed

Jabs, D. A., Natta, M. L., Kempen, J. H.. Characteristics of patients with cytomegalovirus retinitis in the era of highly active antiretroviral therapy. Am. J. Ophthalmol. 133: 1 (2002), 48–61CrossRef Google Scholar PubMed

Robinson, M. R., Reed, G., Csaky, K. G., Polis, M. A., & Whitcup, S. M.Immune-recovery uveitis in patients with cytomegalovirus retinitis taking highly active antiretroviral therapy. Am. J. Ophthalmol. 130: 1 (2000), 49–56CrossRef Google Scholar PubMed

Girard, B., Prevost-Moravia, G., Courpotin, C. & Lasfargues, G.Ophthalmologic manifestations observed in a pediatric Human Immunodeficiency Virus-seropositive population. J. Fr. Ophtalmol. 20: 1 (1997), 49–60Google Scholar

Holland, G. N., Engstrom, R. E. Jr., Glasgow, B. J.. Ocular toxoplasmosis in patients with the acquired immunodeficiency syndrome. Am. J. Ophthalmol. 106: 6 (1988), 653–67CrossRef Google Scholar PubMed

Lynfield, R. & Guerina, N. G.Toxoplasmosis. Pediatr. Rev. 18: 3 (1997), 75–83CrossRef Google Scholar PubMed

Hammond, C. J., Evans, J. A., Shah, S. M., Acheson, J. F. & Walters, M. D.The spectrum of eye disease in children with Acquired Immune Deficiency Syndrome due to vertically transmitted Human Immunodeficiency Virus disease: clinical findings, virology and recommendations for surveillance. Graefes Arch. Clin. Exp. Ophthalmol. 235: 3 (1997), 125–9CrossRef Google Scholar PubMed

Kestelyn, P., Lepage, P., Karita, E. & Perre, P.. Ocular manifestations of infection with the human immunodeficiency virus in an African pediatric population. Ocul. Immunol. Inflamm. 8: 4 (2000), 263–73CrossRef Google Scholar

Fine, H. F., Smith, J. A., Murante, B. L., Nussenblatt, R. B. & Robinson, M. R.Frosted branch angiitis in a child with Human Immunodeficiency Virus infection. Am. J. Ophthalmol. 131: 3 (2001), 394–6CrossRef Google Scholar

Robinson, M. R., Fine, H. F., Ross, M. L.. Sino-orbital-cerebral aspergillosis in immunocompromised pediatric patients. Pediatr. Infect. Dis. J. 19: 12 (2000), 1197–203CrossRef Google Scholar PubMed

Robinson, M. R., Salit, R. B., Bryant-Greenwood, P. K.. Burkitt's/Burkitt's-like lymphoma presenting as bacterial sinusitis in two Human Immunodeficiency Virus-infected children. Acquired Immune Deficiency Syndrome Patient Care STDS 15: 9 (2001), 453–8Google Scholar

Shuler, J. D., Holland, G. N., Miles, S. A., Miller, B. J. & Grossman, I.Kaposi sarcoma of the conjunctiva and eyelids associated with the acquired immunodeficiency syndrome. Arch. Ophthalmol. 107: 6 (1989), 858–62CrossRef Google Scholar PubMed

Keane, J. R.Neuro-ophthalmologic signs of Acquired Immune Deficiency Syndrome: 50 patients. Neurology 41: 6 (1991), 841–5CrossRef Google Scholar PubMed

Smith, D. D., Robinson, M. R., Scheibel, S. F., Valenti, W. M. & Eskin, T. A.Progressive multifocal leukoencephalopathy (Progressive Multifocal Leukoencephalopathy) in two cases of cortical blindness. Acquired Immune Deficiency Syndrome Patient Care 8: 3 (1994), 110–13Google Scholar PubMed

Kestelyn, P., Taelman, H., Bogaerts, J.. Ophthalmic manifestations of infections with Cryptococcus neoformans in patients with the acquired immunodeficiency syndrome. Am. J. Ophthalmol. 116: 6 (1993), 721–7CrossRef Google Scholar PubMed

Marion, R. W., Wiznia, A. A., Hutcheon, R. G. & Rubinstein, A.Fetal Acquired Immune Deficiency Syndrome syndrome score. Correlation between severity of dysmorphism and age at diagnosis of immunodeficiency. Am. J. Dis. Child. 141: 4 (1987), 429–31CrossRef Google Scholar PubMed

Smith, J. A., Mueller, B. U., Nussenblatt, R. B. & Whitcup, S. M.Corneal endothelial deposits in children positive for human immunodeficiency virus receiving rifabutin prophylaxis for Mycobacterium avium complex bacteremia. Am. J. Ophthalmol. 127: 2 (1999), 164–9CrossRef Google Scholar PubMed

Arevalo, J. F., Russack, V. & Freeman, W. R.New ophthalmic manifestations of presumed rifabutin-related uveitis. Ophthalmic Surg. Lasers 28: 4 (1997), 321–4Google Scholar PubMed

Johnson, T. M. & Desroches, G, . Panuveitis associated with rifabutin prophylaxis in a pediatric Human Immunodeficiency Virus-positive patient. J. Pediatr. Ophthalmol. Strabismus 35: 2 (1998), 119–21Google Scholar

Whitcup, S. M., Dastgheib, K., Nussenblatt, R. B., Walton, R. C., Pizzo, P. A. & Chan, C. C.A clinicopathologic report of the retinal lesions associated with didanosine. Arch. Ophthalmol. 112: 12 (1994), 1594–8CrossRef Google Scholar PubMed

Davis, J. L., Taskintuna, I., Freeman, W. R., Weinberg, D. V., Feuer, W. J. & Leonard, R. E.Iritis and hypotony after treatment with intravenous cidofovir for cytomegalovirus retinitis. Arch. Ophthalmol. 115: 6 (1997), 733–7CrossRef Google Scholar PubMed

Shah, G. K., Cantrill, H. L. & Holland, E. J.Vortex keratopathy associated with atovaquone. Am. J. Ophthalmol. 120: 5 (1995), 669–71CrossRef Google Scholar PubMed

Wilhelmus, K. R., Keener, M. J., Jones, D. B. & Font, R. L.Corneal lipidosis in patients with the acquired immunodeficiency syndrome. Am. J. Ophthalmol. 119: 1 (1995), 14–19CrossRef Google Scholar PubMed

Accessibility standard: Unknown

Why this information is here

This section outlines the accessibility features of this content - including support for screen readers, full keyboard navigation and high-contrast display options. This may not be relevant for you.

Accessibility Information

Accessibility compliance for the PDF of this chapter is currently unknown and may be updated in the future.