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Assessment of Syphilitic Optic Neuropathy: A Prospective Cross-Sectional Study
Kui-Fang Du1, Hai-Yan Li2, Xiao-Dan Wang2
1Department of Ophthalmology, Beijing Youan Hospital, Capital Medical University, Beijing, China.
Ocular Immunology and Inflammation
|March 6, 2025
Summary
Syphilis optic neuropathy (SON) can present as asymptomatic optic disc edema or severe optic atrophy, independent of other syphilis manifestations. Early ophthalmic screening and treatment are crucial for preserving vision in syphilis patients.
Area of Science:
- Ophthalmology
- Neurology
- Infectious Diseases
Background:
- Syphilis is a complex systemic infection caused by *Treponema pallidum*.
- Neurosyphilis, a serious manifestation, can affect the central nervous system, including the optic nerve.
- Syphilis optic neuropathy (SON) is an underdiagnosed condition that can lead to vision loss.
Purpose of the Study:
- To characterize the clinical presentations of syphilis optic neuropathy (SON).
- To investigate the pathogenesis of SON by analyzing peripapillary retinal nerve fiber layer (pRNFL) thickness.
- To determine the relationship between SON and syphilis activity markers.
Main Methods:
- A prospective cross-sectional study screened 577 syphilis patients for SON.
- SON was defined as isolated optic neuropathy without syphilitic uveitis.
- Clinical data, fundus imaging, fluorescein angiography, and spectral-domain optical coherence tomography (SD-OCT) for pRNFL were analyzed.
Main Results:
- SON occurred in 4.3% (optic disc edema) and 1.2% (optic atrophy) of syphilis cases.
- Optic disc edema was often asymptomatic with good visual acuity but showed leakage on angiography.
- Optic atrophy presented in males with severe vision impairment and no leakage; higher RPR levels correlated with SON.
Conclusions:
- SON can manifest as asymptomatic optic disc edema or blinding optic atrophy, acting as independent reactions.
- These findings underscore the importance of ophthalmic screening in syphilis patients.
- Prompt treatment for neurosyphilis is essential to prevent irreversible vision damage.
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