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Ocular syphilis.

Grace L Tsan1, Richard T Claiborne2

  • 1Optometry Service, Veterans Affairs Portland Health Care System, Portland, OR, USA.

Clinical & Experimental Optometry
|April 8, 2021
PubMed
Summary

Ocular syphilis, an inflammatory eye disease caused by Treponema pallidum, presents diverse symptoms. Early diagnosis and treatment are crucial to prevent vision loss, especially with its current resurgence.

Keywords:
Diagnosismanagementmanifestationsocular syphilisresurgence

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Area of Science:

  • Infectious Diseases
  • Ophthalmology
  • Microbiology

Background:

  • Syphilis, caused by *Treponema pallidum*, is a systemic inflammatory disease with potential ocular manifestations at any stage.
  • Ocular syphilis presents with diverse symptoms, often mimicking other eye conditions, complicating clinical diagnosis.
  • A global resurgence of syphilis necessitates increased awareness of its ocular manifestations among clinicians.

Purpose of the Study:

  • To highlight the importance of considering ocular syphilis in the differential diagnosis of various ocular inflammatory conditions.
  • To emphasize the diagnostic challenges and necessary workup for ocular syphilis.
  • To underscore the curability of ocular syphilis with timely diagnosis and appropriate treatment, while warning against visual impairment from delayed diagnosis.

Main Methods:

  • Review of clinical presentations, diagnostic strategies, and treatment guidelines for ocular syphilis.
  • Emphasis on serological testing (treponemal and nontreponemal) for presumptive diagnosis.
  • Recommendation for cerebrospinal fluid and human immunodeficiency virus co-infection testing.

Main Results:

  • Ocular syphilis can affect any part of the eye and occur at any stage of the disease.
  • Diverse presentations often lead to delayed diagnosis, increasing the risk of permanent visual impairment.
  • Serological tests are key for diagnosis, and treatment follows neurosyphilis guidelines, with penicillin G as the preferred agent.

Conclusions:

  • Ocular syphilis is a curable condition with prompt diagnosis and treatment.
  • Clinicians must maintain a high index of suspicion for ocular syphilis, especially in patients with uveitis, high-risk behaviors, or treatment failures.
  • Familiarity with the varied manifestations, diagnostic methods, and treatment protocols for ocular syphilis is essential due to its resurgence.