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Optic Disc Edema in Syphilis.

Anna Kabanovski1, Laura Donaldson, Trishal Jeeva-Patel

  • 1Faculty of Medicine, University of Toronto (AK); Department of Ophthalmology and Vision Sciences, Faculty of Medicine (LD, TJ-P, EM); Division of Neurology, Department of Medicine, Faculty of Medicine (EM), University of Toronto, Toronto, Canada.

Journal of Neuro-Ophthalmology : the Official Journal of the North American Neuro-Ophthalmology Society
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PubMed
Summary
This summary is machine-generated.

Syphilis can cause optic nerve head swelling, often with subtle eye inflammation. Early recognition and treatment with penicillin are crucial for visual recovery in syphilitic optic neuropathy.

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Area of Science:

  • Ophthalmology
  • Neuro-ophthalmology
  • Infectious Diseases

Background:

  • Syphilis is an uncommon cause of optic nerve head edema.
  • Differentiating syphilitic optic neuropathy from other causes of optic nerve swelling can be challenging.
  • This study defines the presentation of ocular syphilis with optic nerve head swelling without overt intraocular inflammation.

Purpose of the Study:

  • To define the phenotypic presentation of ocular syphilis presenting with optic nerve head swelling.
  • To facilitate early recognition and treatment of syphilitic optic neuropathy.
  • To discuss potential pathophysiological mechanisms of syphilitic optic neuropathy.

Main Methods:

  • Retrospective case series.
  • Inclusion of patients presenting to a tertiary neuro-ophthalmology practice.
  • Evaluation of patients with optic nerve head swelling without overt intraocular inflammation, diagnosed with syphilis.

Main Results:

  • Four patients (mean age 43) were included, with 2 having bilateral involvement.
  • Two patients had a history of rash; one had abdominal pain and elevated liver enzymes.
  • Subtle chorioretinitis (appreciated on fundus autofluorescence in 3/4) and optic perineuritis (on neuro-imaging in 3/4) were noted. Visual outcomes varied after intravenous penicillin treatment.

Conclusions:

  • Systemic symptoms are common in syphilitic optic neuropathy.
  • Optic disc edema in syphilis is often accompanied by subtle chorioretinitis, best seen on fundus autofluorescence.
  • Optic perineuritis is a common finding, potentially linked to meningitis in neurosyphilis.