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Syphilitic scleritis and episcleritis: A review
Melissa K Shields1, João M Furtado2, Stewart R Lake1
1College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia.
Summary
Syphilis can cause sight-threatening scleritis and episcleritis. Early antibiotic treatment leads to good visual outcomes, highlighting the importance of syphilis testing in these rare ocular conditions.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Syphilology
Background:
- Scleritis and episcleritis are rare but serious ocular manifestations of syphilis.
- Ocular syphilis, particularly these inflammatory conditions, remains under-recognized.
Purpose of the Study:
- To comprehensively describe syphilitic scleritis and episcleritis.
- To analyze demographics, clinical features, management, and outcomes of these conditions.
Main Methods:
- Systematic review of English literature on syphilitic scleritis and episcleritis.
- Analysis of 44 patients with scleritis and 9 with episcleritis.
Main Results:
- Anterior scleritis was most common (92.9%), predominantly nodular anterior scleritis (58.1%).
- Nearly 25% of patients were co-infected with human immunodeficiency virus (HIV).
- Initial misdiagnosis was frequent, delaying appropriate antibiotic treatment; however, rapid response to antibiotics was typical (often within 1 week).
Conclusions:
- Syphilitic scleritis and episcleritis require prompt diagnosis and antibiotic treatment for favorable visual outcomes.
- Given rising syphilis rates, screening for this infection is crucial in patients presenting with scleritis or episcleritis.
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