Infection with HIV does not appear to predispose patients to bacterial keratitis, although bacterial and fungal keratitis can occur in patients with AIDS who have no obvious predisposing factors such as trauma or topical corticosteroid use. Infections appear to be more severe and are more likely to cause corneal perforation in patients with AIDS than in immunocompetent patients. Similarly, herpes simplex keratitis does not appear to have a higher incidence in patients with AIDS, but it may have a prolonged course or multiple recurrences and involve the limbus. Microsporidia have been shown to cause a coarse, punctate epithelial keratitis with minimal conjunctival reaction in patients with AIDS (Fig 15-6). Electron microscopy of epithelial scrapings has revealed the organism, which is an obligate, intracellular, protozoal parasite.
Solitary granulomatous conjunctivitis caused by cryptococcal or mycotic infections or by tuberculosis can occur in HIV-infected persons. The possibility of dissemination must be aggressively investigated and, if present, treated. Both orbital and intraocular lymphomas have been described in patients with AIDS.
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.