Acquired immunodeficiency syndrome (AIDS) and the eye (See Chapter 9).

Kaposi’s sarcomas, purplish or brown nonpruritic nodules or macules, are a frequent early manifestation of AIDS. Commonly affecting the face, especially the tip of the nose, the lesions may involve the eyelids and the conjunctiva.

Fundus lesions are divided into ‘noninfective’ and ‘infective’ categories. Noninfective changes consist of cotton-wool spots, haemorrhages and vascular sheathing. These occur in up to 40 per cent of patients with the disease. Infective lesions are usually caused by a cytomegalovirus infection. These lesions may have been described as tomato ketchup and salad cream retinopathy’, but the pattern is now changing and not so florid. Herpes zoster, toxoplasmosis, pneumocystis and candidiasis lesions can also occur in the retinae. Cytomegalovirus retinitis can be prevented from spreading by treatment with ganciclovir or foscarnet or a combination of the two. These are, however, toxic in the doses required: ganciclovir to the leucocytes, foscarnet to the kidneys.

Intravitreal injections of ganciclovir twice a week until the condition regresses is an alternative if systemic treatment is not tolerated. Intravitreal implants of ganciclovir or foscarnet are now being used.

Neuro-ophthalmological complications in AIDS have been reported, most frequently as nerve palsies associated with intracranial infections with crypotococci and toxoplasmosis, or as a manifestation of an intracranial lymphoma.