Interstitial keratitis in untreated latent (late) syphilis

Area of Science:

• Ophthalmology
• Infectious Diseases
• Neurology

Background:

• Untreated latent syphilis is a potential cause of interstitial keratitis and refractive errors in the elderly.
• Ocular manifestations of syphilis require thorough investigation, including serological testing.

Observation:

• Six case histories from 1962-1979 at The Royal Victorian Eye and Ear Hospital illustrate the presentation of syphilis in older patients.
• Patients presented with refractive problems attributed to interstitial keratitis.

Findings:

• Serological tests are vital to ascertain past syphilis treatment adequacy.
• Cerebrospinal fluid analysis is essential to rule out asymptomatic neurosyphilis, necessitating inpatient therapy.
• Penicillin treatment is indicated for latent syphilis, with outpatient administration feasible if the central nervous system is unaffected.

Implications:

• Early and accurate diagnosis of latent syphilis is critical for managing ocular complications.
• Neurosyphilis requires prompt and intensive systemic treatment.
• Appropriate management of latent syphilis, even without CNS involvement, can prevent serious long-term sequelae.