VENEREAL EYE DISEASE
Venereal eye disease? Strangely enough, nearly all diseases which are
considered to be sexually transmitted diseases can have significant
ocular involvement. This can occur as a direct infection, as with gonorrhea
or chlamydia, or as a secondary infection, as with AIDS. Therefore,
it is important to inform your ophthalmologist of any sexually transmitted
diseases which you may have been treated for if you are having an eye
problem. These diseases include:
||Herpes is a virus which commonly causes sexually transmitted
disease, usually in the form of genital ulcers. In women, active
and potentially contagious ulcers may give no symptoms. Fever blisters
are also caused by the herpes virus, although usually a different
strain of the virus. Both strains can cause eye disease by direct
infection. Once herpes causes an infection, the virus can become
dormant in a nerve supplying sensation to the area infected. At
a later time (sometimes years) a recurrent infection can then occur
if the virus becomes reactivated.
- The first time that the herpes virus infects the eye, it can cause
conjunctivitis, or "pink eye". Usually one eye would be
involved, and it may be a mild or even unnoticed infection. Possible
symptoms could include eye redness, watery discharge, blister formation
on the eyelids, and a scratchy sensation. Once the infection runs
its course, a reactivation could occur at a later date.
- Corneal disease
- The cornea can be affected usually as a reactivation of a prior
ocular herpes infection. Usually, one eye is involved, but both could
be. Genital herpes does not have to be active at the same time as
the corneal infection. The cornea is the clear part of the eye through
which we see. Symptoms could include eye redness, scratchy sensation,
pain, sensitivity to light, and blurred vision. Herpes involving the
cornea tends to leave scars, which could permanently affect the vision.
Treatment is available in the form of antiviral eyedrops, and close
follow-up with an ophthalmologist is advised to prevent visual loss.
- Iritis is inflammation within the eye, similar to how arthritis
is imflammation within a joint. Herpes can cause iritis by itself,
or in combination with a corneal infection. Symptoms of iritis usually
can include sensitivity to light, aching, and blurred vision. Treatment
is with anti-inflammatory eyedrops with or without antiviral eyedrops,
and close follow-up by an ophthalmologist.
|Syphillis is re-emerging as a common sexually transmitted
disease, even though it is easily treated by penicillin. The organism
causing this is a spirochete, or a sort of spiral shaped bacteria.
When it is first acquired, an ulceration can occur at the genital
area of contact (about 3 weeks after exposure), but this usually
disappears without treatment. Women may not notice the ulceration
if it is internal. The disease is contagious while this ulceration
is present. The disease then goes through different stages, and
can involve many different parts of the body, including the brain
and eyes. Laboratory testing can confirm the active and inactive
stages of the disease.
- Corneal disease
- The cornea, or clear part of the eye, can be involved in the early
stages of syphillis by a condition called "interstitial keratitis".
This can lead to scarring of the cornea and visual loss. Treatment
is by treating the underlying disease (the syphillis itself).
- Syphillis may be a relatively common cause of intraocular inflammation,
or iritis. Symptoms can include eye redness, pain, sensitivity to
light, and floaters. Treatment is with ocular steroids, and by treating
the underlying syphillis if it has not been treated.
- Optic nerve involvement
- In advanced and long term (years) untreated syphillis, the central
nervous system can be involved (the brain and spinal cord). The optic
nerve can also be affected, leading to inflammation or degeneration
of the nerve. The main symptoms could be a loss of vision and blind
spots in the peripheral vision. Treatment is by intravenous penicillin
for at least 10 days.
- Other ocular structures
- Syphillis can involve nearly every part of the eye, including the
retina, the gland that produces tears, and the muscles that control
eye movement. Changes in the pupil shape can also occur.
||The HIV virus does not usually cause eye disease in
and of itself. However, the way that the immune system becomes suppressed
in AIDS can lead to unusual eye conditions that normally would not
affect a person with a normal immune system. These conditions can
affect nearly every part of the eye, orbit, and entire visual system.
Some of the more common problems are discussed here:
Manifestations of AIDS affecting the external part of the eye
- Dry Eye
- Patients with AIDS are more prone to developing a dry eye problem
due to inflammatory disease affecting the tear glands themselves.
- Kaposi's sarcoma
- Kaposi's sarcoma is a malignancy which can affect up to 30% of patients
with AIDS. This can involve the eyelids also, as a violet colored,
flat or nodular growth. This can also involve the conjunctiva, or
lining over the white part of the eye. Different treatment options
are available for this disorder.
- Molluscum Contagiosum
- This disorder can occur in non-AIDS patients as small flesh-colored
nodular growths on the skin which tend to spread. In AIDS, there tend
to be much larger and more numerous growths, and these often will
recur after excision. The growths are caused by a virus, which can
cause eye irritation if located at the edge of the eyelid.
- Corneal infection
- There is a risk of spontaneous corneal infection in patients with
AIDS, especially when associated with IV drug abuse. Unusual causes
of infection, such as fungus infections, and more difficult to treat
infections may be encountered. There may be greater risk of reactivation
of viral infections affecting the cornea such as herpes virus and
shingles (reactivation of the chicken-pox virus, or zoster).
Internal ocular complications of AIDS
- AIDS retinopathy
- This is a finding that can be seen in the retina of patients with
AIDS, but usually does not indicate infection of the retina. Small
white patches can be seen scattered in the retina, called "cotton
wool spots". Usually these have no visual consequence, and similar
findings can be seen in the retina with other vascular diseases such
- CMV retinitis
- Cytomegalo virus (CMV) infection of the retina can cause significant
visual loss in AIDS patients. This virus is usually acquired during
life as a flu-like illness, and then becomes dormant. However, with
AIDS it can reactivate in numerous locations in the body. With retinal
infection, symptoms can include seeing floaters, developing a blind
spot in part of the vision, or experiencing loss of vision. Any AIDS
patient with these symptoms should be seen rapidly by an ophthalmologist.
The condition can be treated by IV anti-viral medication, and by other
means. There may be a chance of retinal detachment with this condition
- Toxoplasmosis retinits
- Toxoplasmosis is a parasite that most people are exposed to at some
point in their lives, but it usually does not cause disease. Cat feces
and raw or undercooked meat are common sources. Once in the body,
the organism becomes dormant and encysted. In AIDS, it can become
reactivated in the eye and brain. With a retinal infection, symptoms
usually include severe floaters and blurred vision due to inflammatory
debris being liberated into the fluid filled center of the eye. The
eye may become red and painful due to inflammation. Pain is not usually
experienced with CMV retinitis. The vision can be permanently affected
by this condition. Treatment is with certain oral antibiotics, but
toxoplasmosis may recur.
- Viral diseases
- Herpes and Shingles (chicken-pox virus) may both cause retinal infection.
Antiviral medication may treat the condition. Fungal infections and
syphillis can also affect the retina.
AIDS related disorders affecting the orbit and optic nerves
- Orbital diseases
- The orbit (or the boney socket that holds the eye, muscles, and
nerves) can be affected by AIDS. Disease of the orbit usually causes
eye protrusion, lid swelling, double vision, blurred vision, and possibly
pain. Non-infectious causes can include cancer such as lymphoma. Inflammation
of the orbital contents (pseudo-tumor) can simulate a growth or infection
behind the eye. Infectious causes can include aspergillosis (a fungus)
spread from the sinuses.
- Optic nerve disorders
- Swelling of the optic nerve (papilledema) can be causes by infections
involving the brain such as toxoplasmosis or lymphoma. An actual infection
of the optic nerve by cryptococcus (a fungus) can cause swelling of
the nerve leaving the eye with a sudden loss of vision (often in both
eyes). Syphillis can also cause infection of the optic nerves.
Importance of Early Detection of Ocular Problems from AIDS
From the above discussion, it may seem that there are a hopeless number
of possible ocular problems related to AIDS. Fortunately, however, nearly
all of the listed conditions are treatable, especially if caught in
the early stages. It is important for any person with AIDS who develops
a red eye, blurred vision, floaters, a painful eye, or double vision
to seek medical attention immediately. Sometimes an ocular condition
can signal an infection in the brain or elsewhere in the body, so immediate
treatment can benefit more than just the vision.
Gonorrhea is a common sexually transmitted bacterial disease and can
also be present as a urinary tract infection. Serious gonorrhea infections
can cause complications involving the joints, heart, skin, liver, brain
(meningitis), and eye. Ocular infection with gonorrhea is usually by
direct hand to eye spread. A rapid infection of the lining over the
eye and inside of the eyelids can ensue (conjunctivitis), with severe
pus-like discharge. The cornea can be directly involved (corneal ulcer),
and spread even into the eye is possible.
Treatment of the condition is by appropriate antibiotics, usually given
IV or IM (injection into a muscle). Irrigation of the eye itself can
help, as can local antibiotics onto the eye. Usually, testing for other
venereal diseases such as syphillis and chlamydia are performed, and
sexual contacts may need treatment as well.
Chlamydia is an organism similar to a bacteria which frequently causes
urinary tract disease and genital disease (often without symptoms in
women). Ocular spread occurs in about 1 in 300 cases of genital disease.
A conjunctivitis (pink eye) results, often starting in one eye. Symptoms
are similar to the typical viral conjunctivitis which adults can get,
including a red, itchy eye with mucoid or watery discharge. The cornea
can be irritated in some cases leading to a scratchy sensation. The
infection is often long-lasting (more than 2 weeks), and does not respond
to eye antibiotics alone.
Treatment is with oral antibiotics, once the disease is suspected.
This will also treat any urinary or genital infection as well. The duration
of treatment is usually 3 weeks, and sexual contacts should be tested
and treated as well.
Oddly enough, the species of lice which can reside on the eyelashes
is the same as that found in the pubic region, the "crab louse"
(Phthirus pubis). Thus, this can be considered a venereal disease,
and is usually acquired from sexual contacts. The common head or body
louse usually does not invade the area around the eyes. Red itchy eyes
and eyelids are common symptoms, and there may be a history of lice
elsewhere on the body. The creature can be seen under magnification
at the base of the eyelashes, and "nits", or small white eggs,
can also be seen. Treatment is by physically removing any lice seen,
and be applying an ointment to the eyelids and lashes for 10 days to
smother any remaining lice. Other areas with hair should be washed with
a shampoo designed to kill lice (available over the counter). These
shampoos should not be used around the eyes. All clothes, bedsheets,
etc. of all family members and sexual contacts should be washed and
dried at the highest possible temperatures.