References UK clinical guidance from the NHS, the British HIV Association (BHIVA), and the British Association for Sexual Health and HIV (BASHH). Last updated: April 2026.
HIV can affect the eyes in several ways, from common dry eye symptoms to serious infections that can threaten vision. The risk is highest in people with very low CD4 counts, but some eye conditions can occur even in people on effective treatment. Regular eye checks and knowing the warning signs can help catch problems early.
Here’s what to watch for and when to seek help.
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Common Eye Problems in HIV
| Condition | CD4 Count Risk | Symptoms |
|---|---|---|
| HIV retinopathy | Any level | Usually no symptoms; cotton-wool spots on retinal exam |
| Dry eyes | Any level | Gritty, sore, watery eyes |
| CMV retinitis | Usually below 50 | Floaters, flashing lights, visual field loss |
| Herpes zoster ophthalmicus | Variable | Painful rash around the eye, blurred vision |
| Toxoplasma chorioretinitis | Below 100 | Blurred vision, floaters, eye pain |
| Kaposi’s sarcoma of the eyelid | Low | Purple or red lesion on the eyelid or conjunctiva |
CMV Retinitis: The Most Serious
Cytomegalovirus (CMV) retinitis is the most important eye condition linked to HIV. It almost only occurs when the CD4 count drops below 50 and can cause permanent vision loss if not treated urgently. Symptoms include:
- New floaters (spots or lines in your vision)
- Flashing lights
- Blurred or lost vision in part of one eye
- Painless — which can delay people seeking help
CMV retinitis is a medical emergency. If you have these symptoms with a low CD4 count, contact your HIV clinic or go to A&E immediately.
Treatment
- CMV retinitis — antiviral drugs (valganciclovir, ganciclovir, foscarnet) plus starting or optimising ART
- Herpes zoster — high-dose aciclovir or valaciclovir
- Dry eyes — artificial tears, lubricating drops
- KS — ART plus local treatment if needed
When to Get Your Eyes Checked
- Any new floaters, flashing lights or vision changes — urgently
- Eye pain or redness lasting more than a few days
- If your CD4 count is below 100, ask about screening for CMV retinitis
- Routine eye tests every 1-2 years as for the general population
Prevention
- Stay on ART and keep your viral load undetectable
- Maintain your CD4 count above 200
- Report any visual symptoms promptly
- Attend regular HIV clinic appointments
Read more: HIV and the immune system | IRIS | What is HIV?
Frequently Asked Questions
Can HIV cause blindness?
Untreated CMV retinitis can cause permanent vision loss, but this is preventable with early treatment and effective ART. It is very rare in people with a CD4 count above 100.
Should I have regular eye exams with HIV?
Standard eye exams every 1-2 years are recommended. If your CD4 count drops below 100, more frequent checks may be needed.
Do HIV drugs affect my eyes?
Some older drugs (particularly didanosine) were linked to retinal problems. Modern ART rarely affects the eyes directly.
Related reading
- A to Z of Sex: Sexual Health Terms Explained
- Alcohol and HIV: What You Need to Know
- Anxiety and HIV: Coping and Getting Support
- Are All STIs Curable?
- Blood Problems and HIV: Anaemia, Low Platelets and More
Sources
- NHS — Sexual health conditions
- BASHH — UK clinical guidelines for STI management
- British HIV Association (BHIVA) — HIV treatment guidelines
- Terrence Higgins Trust — sexual health information
- UK Health Security Agency — STI surveillance data
Steve Page is a recognised expert on Sexually Transmitted Diseases (STDs) and STD treatments, having published numerous articles in peer-reviewed journals and presented his research at conferences around the world. He has an in-depth understanding of the latest medical research on STDs, and is an advocate for the development of new treatments and protocols to improve the health of those affected. In addition to his research, he has dedicated his career to understanding the causes and symptoms of STDs, as well as how to best treat those impacted.
