Just like other organs in your body, your eyes are more vulnerable to infection or other complications when you’re infected with the human immunodeficiency virus (HIV). The virus weakens your immune system by attacking vital white blood cells called T or D4 cells.

Once your defenses against infection are suppressed, you’re at a higher risk for eye problems that wouldn’t otherwise bother you. You should take antiviral medication to optimize your immune system and protect your vision if you are HIV positive.

Regular eye checkups are necessary to detect and control any vision issues before irreversible damage has occurred. Here’s a look at how HIV can affect the eyes. woman hiv awareness

HIV Retinopathy

HIV retinopathy affects the retina and can cause vision loss. You can have this condition without knowing because symptoms are often difficult to detect.

Eye exams can reveal if any retinal damage has occurred. A positive diagnosis is confirmed if the patient’s retina has fluffy white patches called cotton wool spots.

This abnormal finding indicates retinal problems like nerve fiber damage, broken blood vessels, and bleeding. The condition doesn’t usually require medical intervention.

CMV Retinitis

Like acquired immune deficiency syndrome (AIDS), CMV retinitis is a viral infection. You can manage both conditions effectively with medication, but neither has a cure.

Opportunistic viruses like cytomegalovirus (CMV) are the reason why you should do everything possible to prevent your HIV infection from advancing to AIDS. About 20 to 30 percent of AIDS patients have this eye infection.

The virus can strike when you have AIDS, taking advantage of your much-weaker immune system. It can cause bleeding and swelling of the retina, quickly resulting in blindness if not detected and managed early.

Immune Recovery Uveitis

Immune recovery uveitis (IRU) is AIDS-related inflammation of the eye in patients on a highly active antiretroviral therapy (HAART) treatment regimen. It’s somewhat a medical paradox because it occurs after your immune system improved from an initially low T cell count.

The condition is more common in individuals with AIDS-related CMV retinitis. For them, it’s the most common cause of vision loss.

Treatment options to manage eye inflammation and halt vision loss in patients with AIDS-related IRU include:

  • Topical or oral anti-inflammatory drugs (steroids)
  • Surgery for cataracts or other significant structural changes in the eye

Herpes Zoster Ophthalmicus (HZO)

Herpes Zoster Ophthalmicus is a viral infection detected in 5 to 15 percent of people who have HIV. Most experience sore fluid-filled lesions on the face and the skin around the eyes.

It’s associated with inflammation in body parts and organs such as:

  • The eye and parts like the cornea or retina
  • The brain (encephalitis)

Someone with AIDS-related HZO has treatment options that include antiviral medication for herpes infection. Examples are:

  • Acyclovir or famciclovir in responsive cases
  • Foscarnet injections in resistant HZO infections

Kaposi Sarcoma

Kaposi sarcoma is a type of cancer that develops on the eyelids in people who have AIDS. The purple nodular growths, or fleshy masses, are painless, and they won’t hurt your vision. The rare cancer is often treated with radiation therapy and HAART regimens.

If you notice raised bumps of any kind on your eyelids, you should have them looked at by a skin or eye specialist to rule out any danger.

Squamous Cell Carcinoma of the Eyelid

Squamous cell carcinoma (SCC) of the conjunctiva affects eyelid tissues. Like Kaposi sarcoma, SCC is a rare form of cancer, and it can cause vision loss.

HIV isn’t the only condition associated with SCC. Sunlight exposure and human papillomavirus (HPV) infection are known risk factors for it, too.

Dry Eyes

When you have dry eyes with HIV, it means that your eyes’ ability to produce tears has been compromised. This condition can occur after your viral infection triggers inflammatory damage in your eyes.

About 20 percent of people living with HIV experience dry eyes at some point. You can manage the problem with special lubricants and artificial tears.

Infections

A weak immune system with HIV exposes you to the risk of vision-threatening eye infections. Examples of these include:

  • Fungal eye conditions like Candida and Pneumocystis
  • Syphilitic eye disease
  • Herpes simplex keratitis (affects cornea)
  • Gonorrhea
  • Toxoplasmosis (parasitic eye infection)

How to Protect Eye Health with HIV

The best way to protect your eyes if you have HIV is to keep your T cell count as high as possible with antiviral treatments. Also, see your ophthalmologist regularly for eye checkups and timely treatment of any detected vision problems.

Diagnosis

Diagnostic procedures/approaches for eye problems with HIV include:

  • T cell count monitoring/tests
  • Viral load tests
  • Visual acuity tests
  • Slit lamp exams
  • Dilated fundus exams
  • Antigen tests
  • Imaging (MRI/CT scans)
  • Biopsies
  • Schirmer test
  • Bacterial culture

Treatment

A HAART regimen can help keep your immune system strong enough against AIDS and eye infection. However, there are usually specific treatment options for each HIV-related eye disorder. These may include:

  • Surgical removal (for growths, cataracts, etc.)
  • Anti-inflammatory steroids
  • Antibiotics
  • Antifungal drugs
  • Antiviral drugs for infection like herpes

When to See a Doctor

It’s time to visit a doctor if you have any symptoms of HIV retinopathy:

  • Eye floaters
  • Flashing lights
  • Blind spots
  • Pain in the eyes
  • Lesions on eyelids (even if painless)
  • Blurry vision
  • Dry eyes
  • Red eyes

Monitoring for the appearance of these symptoms is important and a reason to see an eye doctor regularly.

References

HIV Retinopathy. StatPearls.

What is HIV? (May 2021). American Academy of Ophthalmology.

Immune Recovery Uveitis: Pathogenesis, Clinical Symptoms, and Treatment. (June 2014). Mediators of Inflammation.

Ocular Manifestations of HIV. StatPearls.

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