[Abnormalities of the ocular surface in patients with AIDS]

AIDS patients more and more complain from conjunctival symptoms related to dry eyes and conjunctivitis, but little is known about ocular surface abnormalities in these patients. We used impression cytology (IC) and tear IgE to assess inflammatory status of the ocular surface in AIDS.

IC were taken in 30 patients infected by HIV (including 28 AIDS patients). After collecting general clinical information, and CD4 rate, we made a complete ophthalmological examination (Schirmer test, BUT, Lissamine green and tear IgE). IC were processed by an immunofluorescence technique with antibodies to HLA DR: an inflammatory marker normally restricted to conjunctival dendritic cells; and to APO 2.7 an apoptotic cell marker.

Seventy per cent suffered from subjective and/or objective signs, and BUT was abnormal in 70% of patients. Tear IgE was increased in 36% of the eyes, even without known allergy. A decrease in density of dendritic cells and an abnormal expression of HLA DR antigens by epithelial cells were common features in both groups (respectively 90% and 80% of the eyes). An increase of the APO 2.7 marker was significantly found in 70% of eyes. We found no correlation between clinical abnormalities and laboratory findings. However there was a correlation between the blood CD4 decrease and the HLA DR antigen overexpression. Tear IgE were related to HLA DR expression.

This work shows that even when AIDS patients are asymptomatic they may present significant alterations of the ocular surface probably due to their immunological disorders.