AIDS and Your Eye Exam

What Is AIDS?

Acquired immunodeficiency syndrome or AIDS, is a disease that attacks the body's immune system. People with AIDS are more susceptible to certain infections and cancers.

What Causes AIDS?

AIDS is caused by the human immunodeficiency virus (HIV). Patients may be infected with HIV for years before the symptoms of AIDS develop. A person infected with HIV is said to be HIV-positive. Patients are diagnosed as having AIDS when they develop certain infections, malignancies, or other illnesses or abnormalities as specified by the Centers for Disease Control and Prevention (CDC). If an individual is HIV-positive, even if seemingly well and symptom-free, he or she can infect others with the virus.

How Is HIV Transmitted?

The HIV virus can be transmitted through contact with infected blood or body fluids. One of the most common ways the virus is spread is through unprotected vaginal or anal sex (having sex without wearing a condom). The virus can also be spread by sharing needles during intravenous (IV) drug use. Pregnant women who are HIV-positive may transmit the virus to their unborn children. HIV cannot be transmitted by casual contact with a person who is infected with the virus. You cannot become infected by sitting next to, eating with, touching, or caring for a person infected with HIV. You can reduce your chances of exposure to HIV by using condoms during sexual intercourse and by not using IV drugs.

Is HIV Present in the Tears of HIV-positive Patients?

Yes. HIV has been isolated from the surface lining of the eye and in the tears of HIV-positive patients, but the amounts of virus are extremely small. The CDC has reported that the risk of infection from blood and blood-contaminated body fluids, as well as from semen and vaginal fluids, is far greater than from other body fluids such as tears. The CDC does not include "tears" on its list of body fluids that are considered "potentially infectious" in the transmission of HIV.

Can HIV Be Transmitted in the Ophthalmologist's Office?

To date there has been no documented case of transmission of HIV to a patient during a visit to an ophthalmologist's office. Instruments used by an ophthalmologist during surgical or diagnostic procedures are either disposed of after each use or are disinfected prior to reuse. Contact lenses used for fitting patients are handled in the same way. Ophthalmologists follow these procedures to prevent the spread of HIV as well as any other infections. There has been no evidence to suggest that an HIV-infected patient or ophthalmologist poses any measurable risk to non-infected patients if the ophthalmologist takes the proper precautions in his or her office and in the operating room.

Does AIDS Affect the Eyes?

HIV infection makes the body more susceptible to infection with certain viruses, bacteria, fungi, and to the development of some kinds of cancer. The most common ocular problem associated with HIV infection occurs in the retina, which is located at the back of the eye. Changes can occur in the retinal blood vessels of HIV-positive patients, causing small hemorrhages and/ or areas of swelling, which are seen as white spots. Other types of eye infections and dry eye conditions are seen in HIV-positive patients. These can affect contact lens tolerance.

By adulthood, most people have been exposed to herpes viruses, particularly herpes simplex (which causes cold sores and genital sores) and herpes zoster (the virus that causes chicken pox and shingles). These viruses can remain inactive in the body for a lifetime. A normal immune system generally keeps these viruses under control. When the immune system is not working properly, as in HIV-positive patients, the virus can reactivate and cause new infections. Herpes zoster is more prevalent in HIV-positive patients than in healthy individuals. Herpes zoster infection can involve the area around the eye and cause inflammation in the eye itself. If you develop shingles around the eye, it is important to see an ophthalmologist immediately. Of course, you should not continue to wear contact lenses until the eye is completely healed and you have consulted with your ophthalmologist.

Cytomegalovirus (CMV) is another herpes virus. CMV can cause infection in many areas of the body, including the retina. CMV retinitis is the most common, serious infection affecting the eye in patients with AIDS. CMV occurs in about 25% of AIDS patients. The symptoms of CMV retinitis may be subtle. Floaters (floating spots that disturb vision) are the most common initial complaint. The presence of new floaters or flashes of light may be indicators of CMV infection in the eye and should be evaluated promptly by an ophthalmologist. If untreated, CMV retinitis can destroy the entire retina and lead to blindness. Fortunately, there are now several treatments available for CMV infection of the eye that can preserve vision. Studies are underway for ways to prevent CMV infection or treat it more effectively. Other less common AIDS-related eye infections include toxoplasmosis, Pneumocystis, tuberculosis, and syphilis. Pneumocystis infection may occur without any symptoms, but toxoplasmosis, tuberculosis, and syphilis can produce symptoms similar to those of CMV infection. Kaposi's sarcoma, a cancer that occurs frequently in patients with AIDS, can affect the skin of the eyelids and the conjunctiva (the membrane that lines the inside of the eyelid and covers the eyeball). Kaposi's sarcoma rarely has visual consequences and often does not require specific therapy. Lymphoma is another type of cancer that is seen in AIDS patients; lymphoma can affect the tissues around the eye but rarely the eye itself.

If I Am HIV-positive, Can I Wear Contact Lenses?

Yes. There is no inherent reason why you should not wear contact lenses. However, since HIV-positive patients are more susceptible to infection because of their weakened immune systems, it is especially important to strictly adhere to recommended contact lens cleaning and disinfection guidelines. Any time a contact lens is removed from the eye it must be cleaned and disinfected before reinsertion. Since HIV infection can cause changes in your eyes, it is important for your ophthalmologist to be aware of your HIV status. If your eyes become red or irritated, or should any changes in vision develop, contact lens wear should be stopped immediately and your ophthalmologist should be consulted. Patients who are HIV-positive or who have AIDS should visit their ophthalmologist regularly.

The above information is taken from the CLAO Patient Information Pamphlet titled AIDS AND YOUR EYE EXAM. Pamphlet Advisors were Dorothy N. Friedberg, MD, PhD and Susan M. Stenson, MD. Copyright 1994-2004 Contact Lens Association of Ophthalmologists, Inc.