Question

Describe retinal manifestations of AIDS. Discuss the universal precautions to be followed in eye O.T.

Hint:

Following universal precautions is essential to reduce the risk of healthcare-associated infections in the operating room, especially when dealing with HIV-positive patients.

Answer 1

Retinal manifestations of AIDS are commonly seen in patients with advanced HIV infection. The retina can be affected by direct viral infection or secondary to opportunistic infections or neoplasms, leading to various clinical findings.

Step 1: Retinal Manifestations of AIDS:
1. Cytomegalovirus (CMV) Retinitis: - This is the most common retinal manifestation of AIDS. CMV retinitis is characterized by necrotizing retinitis, leading to areas of retinal hemorrhages, exudates, and lesions with a characteristic "pizza pie" appearance. If left untreated, it can lead to retinal detachment and blindness.
2. HIV Retinopathy: - HIV retinopathy is a non-specific retinal finding seen in asymptomatic HIV patients. It is characterized by cotton wool spots, retinal hemorrhages, and microvascular changes. These changes are generally mild and do not cause significant visual loss.
3. Opportunistic Infections: - Apart from CMV, other opportunistic infections like toxoplasmosis and tuberculosis can affect the retina, leading to lesions that may cause vision impairment.
4. Kaposi's Sarcoma: - This is a malignancy associated with HIV infection. When it affects the eye, it may present as a mass in the retina or choroid, often leading to visual disturbances and retinal vascular changes.
5. Retinal Vein Occlusion (RVO): - HIV patients are at increased risk of retinal vein occlusion, which presents with retinal hemorrhages, exudates, and optic disc swelling. RVO is often associated with co-existing systemic vascular conditions.

Step 2: Universal Precautions to Be Followed in Eye O.T.
1. Hand Hygiene: - Strict hand hygiene protocols, including hand washing or sanitizing, should be followed before and after each patient interaction to prevent cross-contamination.
2. Personal Protective Equipment (PPE): - Surgeons and assistants should wear appropriate PPE, including gloves, masks, face shields, and gowns, to protect themselves and patients from bloodborne infections and ocular fluids.
3. Sterile Instruments: - All instruments used in eye surgery must be properly sterilized to prevent any transmission of infections. Disposable instruments should be used where possible.
4. Safe Handling of Sharps: - Sharp instruments such as needles, scalpels, and blades should be handled carefully and disposed of in puncture-proof containers to prevent accidental injuries and potential HIV exposure.
5. Environmental Cleaning: - The operating theater must be regularly cleaned and disinfected, especially between cases, to ensure the area remains sterile and free from harmful pathogens.