External Eye Manifestations
Other ophthalmic manifestations of AIDS include Kaposi sarcoma; molluscum contagiosum; herpes zoster ophthalmicus; and keratitis caused by various viruses, protozoa, conjunctival infections, and microvascular abnormalities. All of these conditions affect mainly the anterior segment of the globe and the ocular adnexa. These conditions are also discussed in BCSC Section 8, External Disease and Cornea.
Ocular Adnexal Kaposi Sarcoma
Human herpesvirus 8 is associated with Kaposi sarcoma. Two aggressive variants of this tumor have been described: an endemic variety especially prevalent in Kenya and Nigeria and a second variant, epidemic Kaposi sarcoma, which was first noted in renal transplant recipients and in patients with AIDS. AIDS-associated Kaposi sarcoma may be found in visceral organs (the gastrointestinal tract, lung, and liver) in up to 50% of patients. Before the availability of potent antiretroviral therapy, ocular adnexal involvement occurred in approximately 20% of patients with AIDS-associated systemic Kaposi sarcoma (Fig 15-5). Histologic investigation shows spindle cells mixed with vascular structures. Treatment of Kaposi sarcoma consists of excision, cryotherapy, radiation, or a combination of these methods and is based on the clinical stage of the tumor as well as its location and the presence or absence of disseminated lesions.
Figure 15-5 Conjunctival involvement in Kaposi sarcoma; hemorrhagic conjunctival tumor.
(Courtesy of Elaine Chuang, MD.)
Figure 15-6 Slit-lamp photograph of cornea showing punctate epithelial keratitis caused by microsporidia.
Excerpted from BCSC 2020-2021 series: Section 9 - Uveitis and Ocular Inflammation. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.