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4.3.4 – Vision

Children have immature visual systems, which makes them more vulnerable to the neuropathic effects of HIV. This vulnerability is present until the child is approximately eight years old and their visual system is more mature.

Few children will complain about visual loss, especially if the problem starts when they are very young. It is very important that all infected children are screened regularly for visual problems.

By the time they reach their early teens, children are likely to experience similar ocular problems to adults.

Potential causes of these impairments and rehabilitation interventions are shown in the table below.

Table 4.3.4: Clinical Aspects of Visual Impairments

Impairments Possible Etiologies Rehabilitation Interventions




  • All children should have their vision screened once a year
  • Eye infections should be treated promptly and appropriately
  • Children with visual problems should be referred for proper visual assessment
  • Children with visual problems should receive the necessary support at school e.g., sit near the front, large text books
“Cotton wool spot”

Microvascular infarct of nerve fibre leading to retinal oedema

Blindness/loss of vision

Retinal haemorrhage

Retinal arterial/vascular occlusion

Optic nerve atrophy



Peripheral retinopathy

Drug toxicity (ddI)