ORBITAL INFECTIONS IN PATIENTS WITH HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION

Background: Opportunistic infections frequently involve the anterior a nd posterior segments of the eye but rarely occur in the orbit in pati ents with human immunodeficiency virus (HIV) infection. The authors ma naged eight patients with HIV and unilateral orbital infections who pr esented between July 1988 and March 1995. Methods: Records of the pati ents were reviewed. A literature review of orbital infections in patie nts infected with HIV also was conducted. Results: There were five men and three women, with a mean age of 33.8 years. The mean CD-4 cell co unt from five of the eight patients was 18.4 cells/mm(3), Invasive asp ergillosis was the most common orbital infection occurring in four pat ients, all of whom had contiguous sinus involvement and intracranial e xtension. Orbital cellulitis with subperiosteal abscesses secondary to ethmoiditis caused by Propionibacterium acnes and Pseudomonas aerugin osa developed in two patients. Orbital cellulitis and panophthalmitis secondary to Staphylococcus aureus endogenous endophthalmitis develope d in one patient, and one patient had presumed syphilitic optic neurit is, orbital periostitis, and necrotizing vasculitis. Five patients had permanent visual loss, including four who had loss of light perceptio n. Four patients died of orbital disease within 1 year of presentation , and three deaths were attributed to intracranial spread of Aspergill us fumigatus. Other organisms reported in the literature that caused o rbital infections in patients with HIV include Rhizopus arrhizus, Toxo plasma gondii, and Pneumocystis carinii. Conclusion: Opportunistic inf ections of the orbit from bacterial, fungal, and parasitic organisms s hould be recognized as a serious complication of systemic HIV infectio n and are associated with a high ocular morbidity and mortality rate.