Adult-onset syphilitic stromal keratitis

To characterize the clinical features and therapeutic outcome of stromal keratitis associated with syphilis in adults.

Observational case series.

We examined the clinical and laboratory records at a single center of individuals with active stromal keratitis who had serological evidence of syphilis by a treponemal specific test.

Five patients, 36 to 81 years of age, developed stromal keratitis during late syphilis. One patient with developmental signs of congenital syphilis had bilateral stromal keratitis. The others were otherwise healthy when they presented with unilateral, nonulcerative, infiltrative keratitis with stromal edema of the peripheral or paracentral cornea and mild to moderate corneal vascularization. All had an appropriate response to topical corticosteroid therapy, and two recovered good vision. Stromal keratitis recurred in two patients months to years later.

Nonulcerative stromal keratitis presents in adults with syphilis as marginal, central, or multifocal stromal inflammation with neovascularization that responds to corticosteroid therapy but occasionally recurs.